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� <br /> r <br /> 1 <br /> r � <br /> °Vef°" APPLICATION FOR PUBLIC WORKS P�RMiT <br /> � TYOB or Drint CIBBr1Y wil�irk � -7 <br /> PRESS HARD•YOU ARE MAKING COPIES pERMIT NO. � •3Z <br /> PUBLIC WORKS <br /> �` EV/ERETf,WASHINGTON / BLDG. DEPT. NO.__ e� <br /> CypWNER ❑ AGENT DATE �n/Z1��-`�--- ., + <br /> � / <br /> 1 �' ) r !'� <br /> APPLICANT/FIRM REPRESENTED --_�.�:'-�:1. '-LLi':'�s-�-�=—`'-`..=--:." --�----- - <br /> , ? ,,- ' `- _./. 1.. . �., ��/i�- CITY�a,,,- ..r� I ��—TELEPHONE .'_,<� - : .=�;-�_. <br /> ADDRESS �"- �-�-�.-�.L ' - / <br /> HEREBY APPLIES FOR PERMISSION TO ���/G--����'������-' C <br /> / �� �� �'''�-. <br /> �L __l.i,��— -- <br /> ATTHEFOLLOWINGLOCATION '3Q�— ��v��r—`�'�"--�- <br /> Attach five(5)copies of preliminary pla�s for proposed work Draw lo scale and show the following as applicable: <br /> ' Property I?nes and street identity. •Topographic changes requiring cuts end fills � <br /> • Outline and dimensions ot existing and . On-shte dha nage systems when required. <br /> proposed st�uctures. <br /> • Existing and proposed utilities. ` Erosion control methods when required. <br /> •Centerline of ab�tting right o!way. ' NORh arrow <br /> �e'_N• (!/L`��..«: -- �! ."i�� <br /> Signatut^nf Aoplicen��({qgu.���FM�L-� <br /> CUNDITIONS: <br /> PUBLIC WORKS PERMIT ` ��' <br /> ��-� a��,-d�� �l«.5- <br /> � r��',`�� ��� �. � <br /> ':::�_. �,� /�n Ot�nPir•S �c� �C� �0�2 � r S�i�ee <br /> :+_ �fh �,f��...t) ��C l�.,d.���,�. <br /> , .�_. <br /> � �. S �,-� i,E'5�cn�.f����c �� .�lr/�7�aa��- � <br /> i_I= �i/a�i�/ v�m�- . <br /> -+ a � s��t���fs �����1 � ����s��,.�. <br /> � :_, : <br /> ��� �a.. , � <br /> , �- -- � �.F-- _.�� �-{-y.1�. , <br /> � � � . <br /> y-�-7�—�'-^-�—�Tt"aa i `T` �y 1 : Tne un0ersigned owner hereby nprees i. �oid a�E e�m���mbw <br /> �4 4 - -1- —1 =—f� �—� � tne Cily ol Evemu Irom any ana au culms lor d�m�qaR coat0. <br /> ' � expense&or ceuses ol eclion�hat mey etlse bec9uw d Inft��INlon <br /> ' -�'-�- � .-�. and malnlonence al ine Improvement or ol�er d9��b�•w�Y ��s <br /> � - herelo aOPl�ed lo�antl luriner e0mee lo romove leme upon no11Ce <br /> � � Irom the Cily antl lo re0�ace oublic property O�m�pad ��eraby. <br /> / <br /> / / <br /> //. / . �' "-�� . � .4Jt'___ <br /> � /0 T� ACKNOWLEDGEMENTOFCONDITIONS <br /> ` �PRO ED OR CON TR CTIQN , . . J <br /> i G <br /> �/ � <br /> �r, �:l/ .� ��j ,fL �i � ' �[c 0:�. .� /o dY�S_'. ��t �fr- <br /> pPPR VE�AS CONSTR CTED i ATE SIGNATURE OF APPLICANT DATE � ��.��4, <br /> PERMIT IS VAUD FOR 1 YEAR CALL FOR INSPECTIO <<=�-4�. I <br /> POST ON 259-8811 <br /> . �; - � • JOBSITE 2q HRS. BEFORE CONSTRUCTION <br /> � EXPIRATION �' ' �' " ' _ <br /> � <br /> � <br />