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"'�'�" APPLICATION FOR PUBLIC WORKS PERMIT <br />e TYVe or Print UaerlY wi�h Ink <br />PRESS HARD • YOU ARE MAKING COPIES �1 Z� Z, <br />PERMIT NO. __ <br />PUBLIC WORKS <br />E`V� RETf, WASHINGTON BLDG. DEPT. NO. <br />�OWNER ❑ AGENT DATE ��q - �a <br />APPLICANT/FIRM REPRESENTED _i.�� L-G C K�S t l.� <br />�, <br />ADDRESS � 3�� ��� � k� v CITY _ J e� 1'-1"F" TELEPHONE n15 $' "�1 '�`� .5 <br />HEREBY APPLIES FOR PERMISSION TO _�_r.1 \' `e<.i" v f� ti'�' - \I e Y�l m �tic�r - <br />�` t_'e-Ia1V U�D -�'f1��_\r -' F%1'(�C�f. V= rOeJT- t�e.W FLt�Ov -'�te. <br />ATTHE FOLLOWING LOCATION �A'�'n'e � <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />" Property lines and street identity. <br />' Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />' Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-site drainage systems when required. <br />* Erosion control methods when required. <br />' North arrow 1 <br />CONDITIGNS: <br />�.. %� <br />� . � . . �.���uce. e�f�vtwaYT � �S�w.c�� w.Px., owJ� . . <br />�. . . � � . . . . 1 . . . `� . <br />�QyH'Ypr Mpw �d.��JOwP�t 1M QPr�CIM\ �o� q��17� <br />1 1 <br />a�a S�+s�nll .c�f��pw�`� a,�afun 1.Per A'Pi"'/: `.�id � IO <br />r_. 1 TY�v � — ,4}} 2L <br />, � � �.� .SNS; AII �:� SoI.CI . }PaLt —y�( SCfCCN\N� G S S�owH , <br />or. pIANS <br />��. ,.. •. .,%� �TNSYAiI �w/If[l S�p/ S QS Shown O.n� p/AHS . . . . . . . . . . <br />� � O <br />� . . . . . . . . . . � . . . . <br />'.. ���� � :����� <br />The unaersigned owner hereby agrees 10 holC and save harmless <br />� Ine City al Everelt rrom any ana an cialms lor dama0e0. coeta, <br />,.,,, . erpenses, or causes ol action that may arise becauae ol Inatetlatbn <br />,. _. � �� - and maimenance ol Ihe improvement or othar tl9h4ohway uae <br />... . hereto applied lor end furt�er agrees to remova sama upon notice <br />�� �'��/�1'� Z-- <br />�PROVED FOR C NSTRUCTION ATE �'u` <br />n <br />¢ L�� S K� GG (G�P i.o d ��u <br />i <br />'D'ri�'E�1ISIIItleiED DATE <br />PERMIT IS VALID FQn 1 YEAR <br />EXPIRATION � �� �� <br />Irom Ihe Cily and to replece publlc praperty demepe0 t�ereby. <br />ENT�F CONDI� <br />.o.,.�.�t�r.1w� �/�/�-EFL <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />a <br />