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°"� APPLICATION FOR PUBLIC WORKS P�RMIT <br />Type p� pnnl rb•prlV+,ilh mF <br />PRESS HARD � YOU �Rf. MAKING COPIES <br />PUBLIC WORkS <br />EVERETT,WASHINGTON <br />f 1 OWNEFi I 1 AGENI' DATE �'� �. �_ �_ � I <br />APPLICANT/FIRM REPRESENTEp � . �-I,>'�'.� `-_ 1.. _ _ L - <br />'` <br />AQDRESS � � � � �'�� �-� � _ <br />HEREBV APPLIES FOR PERMISSION TO !�"' � C _. � <br />AT THE FOLLOWING LOGATION ' � � <br />PERMIT NO. <br />BLOG. DEPT. NO. <br />� � J <br />CITY ty, .' ! _ • _! 1� <br />r `��� ;, <br />\� �'-� �..-0..�-�-"j <br />TELEPHONE �- S ) - 7 6L', <br />� � '� �. ? . . '. .. `�__'�`(. <br />J <br />Attach five (5) copies ol preliminary plans for proposed work. Draw to scale and show the fol�owing es appliceble: <br />F'roperty lines and street identity. <br />Outline and dimensions of existir�g and <br />proposed structurPs. <br />Fxisting and proposed u(ilities. <br />Centerline ol abutling right of way. <br />GONUIfIONS: <br />A <br />' Topographic changes requiring cuts and fills <br />other lhan normal toundation. <br />' On-site drainage systems when required. <br />• Erosion contrul methods when required <br />• North arrow <br />� ..�:r.:ii����.,naru� :n�� .. <br />PUBLlC WORKS PERMIT <br />� . i�.i��'-��... �.hr'2". <br />�i^+tr ts ^ovhrrtovn��� <br />r�,11TTP.f '2�C�Y;N17C•t TfIAT P': ` ,.� <br />;�IT-OF-�LA'r AND ,qf,REES THA� SH�Ii_I <br />��Gti 105T[1 �lq INSTAI.I_ ANl' 4f1C11T1�)'•IA�_ ; I_I; I'.; '; i i''. <br />,��r_��r-wqv, THAT ifF w11.L �tF�.�nve rfir-, Fr-�.i�r 4T yn ^n <br />. ,��r �r;,� ..,.._.. ..,..�., . _ . ... :.. ... ... .... . . .. <br />r <br />•.r <br />DATE <br />(lAT � <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION -.— <br />. , . .. .. i ,.i., .i.�...�.. . . .�a1 :�r.�� ":n,. M1 ,iio.r.,s <br />Ilu� �.ny ui f:rn•11 hoin any mnt an clannt loi tl9mlOB!_ COlIc <br />napeimea. o� ceueea ot eclion Ihel mey enee Oeceuee ol Ineteilelro� <br />entl memtenenr,P nl Ihe improvemnnl or oMe� riB�bol�way oee <br />horelo app�ied lo� anA luqher eqreee In inmov� emm� un��n noWv <br />Irom t�a C11Y end fo �e0leca PuDbc p���n�.r�� dmm�y�,d I�,r�rb•: <br />/ <br />'/ ACKNOWLEDGEMENT OF Ct7NbITli ��J'�• <br />Z�J�L SIGNA�URE UF AP�LICANT�� �♦ �� DAtE ��. � <br />� <br />CALL FOR INSPECTION <br />POS7 ON 259-8811 <br />JOBSITE 2q HR5. BEFORE CONSTRUCTIOI'� <br />, <br />