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evereit A�jPLICATION fFOR PUBLIC VIiiJRKS PERMIT <br />� TYPe or Print clearly wilh ink o <br />PRESS HARD - YOU ARE MAKING COPIES pa2 �pf <br />PERPAIT NO. __ a <br />PUBLIC WORKS <br />EVERErf, WASHINGTON ( � BLDG. DEPT. NO._�'2 O'��O <br />�� J � -?, :.) <br />�OWNER ❑ AGENT DATE _ ____,. ._-- —._ <br />/Li ! 7it E;� _ �l,+-''`-- <br />APPLlCANT/FIRMREPRESENTED �L_ _.�_-�------- ----------------- - <br />;> i�j' `__C.i (/L.%lr" ' f L 6�I�/�l /CITY _L-I�(-:KF%%� TELEPHONE -.iS S G/�/ <br />ADDRESS _ ` 1�1�� <br />HEREBY APPLIES FOR �ERMISSION TO ���S�f��L �'�S ��f//�� iL�I�L`l ��__�-����� ���/'t `� <br />ATTHE FOLLOWING LOCATION -� ��� <br />i i � �1rr'i�'_': - %.� � � �_] +� <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the foilowing as applicabie: <br />• Property lines and street identity. <br />' Outline and dimensions of existing and <br />�roposed structures. <br />" Existing and proposed utilities. <br />• Ce iterline of abutting right of way. <br />CONDlTIONS: <br />` Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-s!te drainage systems when required. <br />' Ero ion contrul m thods when required. <br />* Nort��LL //_/ � (- — <br />�� ' Sign Wre ol Applicant _ <br />PUBLi�C WORKS PERMIT <br />/' �. <br />�. l�fee.�- t?7c31-� �CtSc� v.�P�n;i- ceren. j'•� no�' —1� 1u� e�en.rr <br />Z� {i00i'-'C�l� Glfn�r�rtJ2. +MNS�' b� CO.s'1�`Ird/ U�. '�C �v�' <br />1 <br />3L ��� �u,,.,��� �; brr«L�t�.. -►o P..b�,� ,2.,,w. n�•�.,:�.�3 �L,� <br />1 1, <br />-�-�p GOvl'�'tf^:lc"Y.o.^� .+�HS�- br +'Y.�Q.rr..i% ��� �'J,n��C�P� <br />/' �e�i^i� '-i-rcte����C ��.,-iro I�.��a��c. F�.O.w -�w.,.. -3-���� ro.�s�l-r. ���<- <br />,5 .� �� �t���.� ...� au,�y . <br />5,� /��-�!'aJt �Ov.. <;rt� %17 <br />6'/aT/�� <br />�i�►I�a3 <br />PERMIT IS VALID FOR 1'fEAR <br />EXPIRATION <br />fitacK +/ac��X � drqy.� . <br />The undersi9ned owner hereby agrees to hold and save harmless <br />Ihe Cily ol Evereu twm any ana au c�aims for damaBes, ws�s, <br />expenses, or causes ol action ihat may arise bocause ol installation <br />and maintonance al the impmvement or ather riph��obway use <br />hereto applied for anC luriher agrees to �emove same upon nolice <br />Irom the City and to replace public proporty damaged thereby. <br />T <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSI7E 24HRS.SEFORECONSTRUCTION <br />� <br />r <br />_; <br />