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"1V <br />� <br />r <br />L <br />r <br />°"°'°" qppL6CATION FOR PUBLIG WORKS PERMIT <br />� TYPe rn)rmt CIe�tlY wilh mM ' / .— <br />PR[SS HARD �"OU RRE MAKING COPIES pERM1T NO. + � �'- `f-� <br />PUBLIC WORKS <br />EVEHETT. WASHI�IG7"ON BLDG. DEPT. NO. _ S3f 116b8 <br />C] OWNER �IS AGENT DA7E '� I��I ° j <br />APPLICANT/FIRMREPFESENTEG �.�t���i� ��115'��;.'�I !I(1?Il�.,ti <br />ADDRESS 713 SiS fvc�ctt �1a11. IQny ._ . Clrv �-�'�rctt TELEPHONE 353-G500 __ <br />4EREBYAPPLIESFOFPERMISSIONTO �onstrUGt singlc familv resldencc ____-- <br />ATTHEFOLLOWINGLOCATION I.ot �1 of 1'etc's �'L�t d'-HCZ IO��P1•_c���__. _—_ <br />Atlach five (5) copies r,1 preliminary plana for proposed work. Draw to scale end show the following as applicable: <br />• PropertY lines end street identity <br />' Outline and dimensions of existina and <br />proposed atructurss. <br />' Existfng end pro�>osed utillties. <br />' Centerline ol abutting right o1 way <br />CONpITIONS. <br />BLI <br />� Topographic chenges requiring cuts and fllls <br />othe� than normel foundation. <br />• On-si�e drainage systems when required. <br />• Erosion control melhods when reyuired. <br />• �'orth arrow <br />- � .� <br />. ._. 'l t/�� � ' <br />� � Sipnelu/edRpabr,an�i �--��� <br />KS P�RMIT <br />I�M �Cf�ION 0'r- A�t �lfWf�vn`� K��N..+ '�L.-P \��\'011�/--� <br />R.� w r. �- I o S� fl 9.`. ,+n�+s F 6< �n�•.X . <br />Z� �}II wo.l� s�...11 c+,..�..... -'� Cal� c� E.,�N� <br />...—..�. . 5`I�S, nv.dl :Je�'r.l�...� uni w�..-I y,�fl�r..b�t <br />'� 1��e, ��� `�' ��w. R .�. �v � <br />,y,� ' IJlz�1�z <br />`�S6iM�lt)�i�-7'�:�iQRil��i"� //"0 % <br />U <br />ih�1 � I�API614lIP(I nwnni ne�eby eqreas lo hold a�d sav+ nermleee <br />I�e Clly ol Everell Irom eny enn en Gaime lor EnnqleG coat�. <br />e�penaee, a ceusee ol eclion I�el msy sib! 6et�4N O� �����������a^ <br />end me�ntennnce al Ina �mpror�menl or ather dpPlo� way we <br />herolo ep0���tl lor anA lurl�nr eqreee t0 romove eeTtl uD� � �oll<e <br />trom !he Cily end lo mVlece pubilc O�oVer1Y ��'���7� �hnre0y <br />/ <br />D O. UCTION 'DATE ACKNOWLEOGFMENT OF CnNDITIONS <br />/ , /i-� ','-�, <br />1- „ /-,( -;,-;' <br />APPROVED AS CONSTRUCTED DATE SfCNATUHE OF �PLIC'ANT� DATE <br />PERM17 IS VALID FOR 1 YEAR CALL FflR INSPECTION <br />POST ON 259•8811 <br />� EXPIRATION -- __ JOBSITH 2�1 HR:�. HEFORE CONSTRUCTIQM <br />1 <br />� <br />"1 <br />i <br />J <br />l <br />J <br />