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�°rctt pppLICATION FOR PUBLIC WORKS PERMIT <br /> � TYoe or Print clearly with ink a <br /> PRESS HAHD•YOU ARE MAKING COPIES pERMIT NO. 0 2 `�S � <br /> PUBLIC WORKS <br /> � :VERETT,WASHINGTON a BLDG. DEPT. NO. <br /> ❑ OWNER ❑ AGENT DATE�_.Q�J/� Z� - e <br /> APPUCANT/FIRMREPRESENTE��_._C%O[i.uL�/-.-_�(�-'!u �«y--�'�S_-_—_- - _. - -- — <br /> ADDRESS�.�J�C�Y I S z /v d�,L �S___ CITY71_7✓1-L31"^—TcLEPHONE � � � --s-7� <br /> HEREBY APPLIES FOR PERMISSION TO _ N'Se �/��� ` s -- --"-- <br /> AT THE FOLLOWING LOCATION a �� ��- Z �5�6 /) `� �J'��'" — ' <br /> Attach five l5)copies of preliminary plans tor proposed work.Draw to scale and show the following as applicable: <br /> ' Property lines and street identity. � Topographic changes requiring cuts and filis <br /> ' Outline and dimensions ot existing and other than normal foundation. <br /> proposed structures. " On-site drainage systems w re� uired. <br /> ' Existing and proposed utilities. ' Erosion c ds en-required. <br /> ' Centerline oi abutting right of way. ' North' o ' <br /> � _�ry � <br /> gnaNre ol ADPlicant <br /> CONDITION5: PUBLIC WO KS IT <br /> �—, —¢— 1 � <br /> . �, '� �..1 -t i <br /> � I1. �. ' � 1_1' t", _4 � ,. I i_� . ._ �. � � � �� <br /> j � Li� � , <br /> y . ,-i � i -�'�-< � f I -' I '� .. f�., }T.� .�-�t ' �.i . . i � ��. � ...1 , -t'. , � �I � f _'I t . <br /> � .j�._._ l --r ; � .. � _:. ; ' i .�.. , . .: _��- � �- ' � � <br /> I ��'� l � � ..L� 4 ,..-i.--iI-� ' _.._� .1. �. ...J� , 1 i ' ,�f ...._1 � 1.� �� � ..I.� �� <br /> �I t � ~ � <br /> � . .�• � � Y i.. I �._ .1 l .-1._ 4 - ' � � � i.. I <br /> +.., � 1 ..� ;,} , � , ; � . � < <. l i � � � <br /> �' l.�. i I � � � � � � ._.. y . <br /> t� 1 � i � : } � <br /> . � , ! � I � � � � � I ' _. .. , �I + <br /> � �1 + 4 <br /> � " � � � i ..� . � . �. i , ' � �- � , i i ; .1 , . � ' � � �� <br /> � <br /> � f i �, � �i � � �_. L . �� � �� ' � ' � _ <br /> � ' . <br /> �..y , , a ... _ <br /> _ _ <br /> 7 1 1 . _ . , � , , ....i._,. � . <br /> t i <br /> � ._;��_; � �� j-, 1 � `_� � ' � { , ` � i ._ <br /> t ._,_,.a_, _ . � 1 i <br /> ; � <br /> �_,..� ._t_--t—�-'- <br /> '�' ' � The undersigne0 owner hereoy agiees to holA and sOVH h0lmle66 <br /> .I... ..t � . <br /> • the City ol Eve%11 vom any ana an daims for damepea, costa, <br /> � '������?�—��� ' eMpe�ses,or causes ol aclion Ihel may arise Decause of Inetallelion <br /> � and maintenance ol t0e improvement or other riph4o4way uea <br /> � hereto applied lor and �urther aBrees to remove seme upon nollce <br /> (: Irom Ihe Cily an0 to re0�ace O�blic pmpetly dema0ed theroDy. <br /> i� <br /> / /� -tr ' � !6 .� L _ ' �' <br /> VEO FOR CON(S�HUCTION DATE� ACKN -EDGEM i�QF CONDITIONS <br /> lC � � �' �. �� �� ����� �/ %�� �_� <br /> i i"(�fi 6�� r`- � ' <br /> A�ROVEDASCONSTRUCTED DATE �'GNAT EQFAPPLICANT OATE% <br /> PERMIT IS VALID FOR 1 YEAR �� CALL FOR INSPECTION <br /> POST ON' 259•8811 <br /> JOBSITE 2a hIRS. BEFORECQNSTRUCTION <br /> EXPIRATION <br />