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i— <br />i'e� APPLICAT�ON i=0� P'iJBLIC \h�ORKS PERII�IT <br />Type or print Ucarty with ink <br />PFiES:�� NAAD - YOU AAE MAKWG COPIES �� �`, % <br />F'UBLIC WORI:S PERMIT NO. _— / <br />WERETT, WASHINGTON _ ., ? c� <br />� a �=� S,�- BLDG. DEPT. NO. �` Q�O[ <br />�OWNEi� ❑ AGENT DATE __ _.__ . ' <br />/ -- -- /-- <br />APPLICNNT/FIRMREPREScNTEDf(,���(�__/!4_'�%�('_i;__ �-�ir <br />ADDRESS <,.%(�, `�, �, r: ��'C. /2[: F/ 6�%�fIC(. /� �CITY G Gc�Ei% TELEPHONE ��� S-(��I� f' <br />HEREBYAPPLIES FOR PERM�SSION TO ��IL���fI<i `�S ,`G �t�� C�fi/6E ;�C%l cL�j�%Lt`<UF� `/ <br />�— <br />ATTHE FOLLOWING LOCATION C� / <br />��lE. � ���'i I�^ � — <br />Attach tive (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 existir,g and <br />proposed structures. <br />' Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />CONDITIONS: <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />` On-site drainage systems when required. <br />' Erosion cpnirol me�hods when required. <br />' NOrth afr6w, <br />PUBLIC WORKS PERMIT <br />�. i�oo�•-�� clrn,,:a�e �n��sl- be cohi'rnllt�! o�•. }l,� �o-}-. <br />�. ip}v�� �0.w.a5�c Y.r brPc•�ccCSc -�'v ������t. I:.O.I.v. . <br />Ucfu��n� c�u� � Co�tSYru.�t 1•a.1 vhyl.5�- ��. .'erJUlrr<� <br />b.� b u � ��et <br />.3. �1�iri7 '�7Y�.c�.�.� t »%� �7w�i�c. <br />� S��FC �S i� �t CICRv�e�1C <br />. � �ciJ us� wa%er <br />�,..T. L . . _ . <br />� .. . � .....+_.1 � :._i_{_ � . ; .': <br />� <br />1 �... � j � � �'�_ <br />i � I <br />(�.O.w �(�c;v.+ �i-�i5 c�t�53-ri..c�io:, <br />� <br />,.�,r �t�„ ►7 , <br />Sc'_rvice. vci�Vc bo7c ^'� irp_��:`, <br />:_; .;. . . .. <br />� <br />ar_,�z <br />�-7� <br />PERMIT !S VALID FOR 1 YEE�R <br />E lRATION <br />The undersiqnetl owner here6y agrees to hold and save harmless <br />the Citv ol cvereu trom any nna au clalms lor damages, costs. <br />expenses, or cuuses ol action that may arisn Decause ol installalion <br />end mainlenance ol ihe imprcvemenl or other righPal�way use <br />herelo applied br and lurther ngrees to ramove soma upon nolice <br />irom Ihe City antl to replace public property damaged Ihereby. <br />F C�oN�-ITIONS <br />�� - (�� 7���0 � <br />� CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECOPi�7RUGTIJN <br />� <br />