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,� a.� <br />"'"�" APPLICA'. JN FOR PUBLIC WO�...S PERMIT <br />� Tvoo or p�im cieedy wuh �nk <br />PRESS HARD - YOU ARE MAKINO COPIES D/�1 _ <br />PEfiM1T NO. �li� <br />PUBLJC WORKS / <br />EVERETf, WASHINGTUN 1 BLDG. DEPT. NO. <br />❑ OWNER O AGENT DATE �` t L �� � � <br />APPUCANT/FIRM REPRESENTE . eL> �ti'r •- , L �'I ' S Vy..d � • ;,. i � ,--? <br />nDDRE8S . _.�. O �- "_I �'-� � �"�F'->_ � _ CITY LY_! •^ �--TELEPHONE % i � • 7 ( c "� <br />HEREBY pPPLIES FOR PERMISSION TO __�".��+'���: -. r 4>5���� ''� _ <br />AT TKE POLLOWINO LOCATION '��^L___ <br />Attach five �5) copies of preliminary plans for proposed work. Oraw to scale and shov� the tollowing ea eppllcable: <br />' Property lines end street Identity. <br />• Outllne and dimensions of existing and <br />prupoaed atructurea. <br />• Existing end proposed utilities. <br />` Centerllne o( ebutting right of way. <br />• Topopraphic changes requlring cuts end fllls <br />other than normal foundetlon. <br />• On•site drainege syatems when requlred. <br />• Erosion control methoda wlien,requfred. <br />` North err��w <br />� <br />...-- <br />1 " � ""�---- <br />Signalu}eol�pD��canl � <br />�� PUBLIC WORKS PERAAIT <br />CONDIT.JNS: <br />l. FP_NCP. ?O AL' NO MORE THAN 36" H1��N <br />2, "PCR�-II7 15 �ONDITIONAL" <br />PF.R•NITTP_E RF,^.00;N17.E5 TH�1T PROI�SFfI PENCF IS IN THE CITY <br />R(CNT-OP-�VAY AN�) ,qGRP.ES TH!1T SHnUl.O THP. CITY F,t,E�T To <br />WI[lEN IOSTH OR INSTf�LI ANY �nDITIO"JAI. UTILITIP.S IN THP <br />RIGHT-OP-'�AY, THAT HE Wt4L R�I���Y[? THC F8N^F: AT NO r,pST <br />TO TNE CITY, AN(1 FURTHER A;Rf?E5 TfIAT TNF. �'IT�' �q11.I_ Ni)T �� <br />LIIlR1,E FOR ITS' RF.PI.A�:F�1PN1'. <br />1 i� <br />'_�_ �__'�_ / <br />q �� VED FOR CJ'ON87P CTTON �� - DATE - <br />APPROVFD AS CC!�SIRUCTEU � DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRA710N—.� '� � ` �' <br />Thv untlereiy� ed ownx� haroby epraee to �oltl an0 enve hermlees <br />!ne G�ly ol fvernll vom �ny antl au eisime lar deme9e�, cosls, <br />erpennee. or :aueee oi ecllon Ihel mey a�Ue ber,auee ol Inet�llellon <br />antl malntenance al Ihe Improvemenl or other riph4ol�w�y u�e <br />harola epplled for e�C �urther �preee lo removs ume upon notke <br />Imm I�e Clly anA lo roplece pu�llc property dam�ped Ihanby. <br />ACKNQWLEOOEMENT OF COF�DITIONS <br />� - � <br />L r� " � � L' L "'L . <br />SI NATU�F APPLICANT� DA E f� <br />POST Old I CALL FOR INSPECTION <br />259•8811 <br />JOBSITE 24 HRS. BEFURE CONSTRUCTIUN <br />