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"'� �� APPLICATION FOR PUBLIC WORKS PERMIT <br />U� <br />PUBLIC WORKS <br />TYOe or prinl cleulY wlln Ink �j <br />PRESS HARD • YOU ARE MAKINd COPIES pERM1T NO. _d1 � z� <br />EVERETf, WASHINGTON - ) BLOG. GEPT. NO. � -�� � <br />� OWNER ❑ AGENT DATE �_�` �_ -�-� <br />�i� � � i <br />APPLICANT/FIRM RLPRESENTED /J_C�w-z.1tw;.--� -/'%d�G`'��------ - <br />r.. / / o � �` �`? � <br />ADDRESS �✓ I� G I /ri �f � l-' CITY L✓ � Y � /% _TELEPHONE-� ��" ' <br />HEREBY APPLIES FOR PERMISSION TO !� 5 c Fn i s T �i � .�%yiY f �✓� �� <br />n7 THE FULLOWING LOCATION ��--� � � r� S .� /' /e r i �% �"� � � <br />Attach five (5) copies o( preliminary plens (or proposed work Oraw to scale end show the following as applicable: <br />` Property Iines and street identity. <br />` Outline and dimensions o( existing and <br />proposed structures. <br />' Existing end proposed utilities. <br />• Centerline of ebutting right ol wAy. <br />' Topographic changes requiring cuts end fllls <br />other than normal foundetlon. <br />• On-site drainage sYstems when requlred. <br />• Eroslon control methods when requlred. <br />• North errow , � <br />OONDITIONS: <br />�. . <br />�... . . <br />�.... . . <br />; �. .. � <br />.... �. . <br />i _.. _. . . . _ . . _ . . . .. . .. . . . . . � <br />j.... .i� ... . ... . <br />�._.._._ � ................. . <br />�.�.......... ..i,... .. <br />�.`-•.'.•.�....•.�•...�.'•�._ • � ..... <br />��...�. :.. . .. . . . <br />i..... . �. . <br />'' __-,_ .._ ........ . ... ..�.. . . . . . . . . . . <br />Y G / <br />�L/_ Z� �?/ <br />A�F CO/'TRUCTION � Up�/ <br />� , __���� <br />APPROVED AS CONS UCTED � OATE ' / <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />Tne unEernipneE owna� �ereby epreee to hoiC en0 �eve �ermles� <br />Ihe Clty ol Ererell Irom �ny �na �n cielm� lor O�m�peti cosls, <br />e.Dennes. ar c�uees ol ecllon �hrl m�y �rl�e bec�we ol ln�l�ll�tbn <br />anA melnlenance ol Ihe Improvamenl or Ol�er tlOhPobwey We <br />herelo �p0lied lor �nd Iunner �pree� lo �emove Ume uvon notice <br />Iwm I�e City an0 lo repbce ouClk property d�m�pe0 I�ereCy. <br />AGKNOWLEDGEMENT OF CONDITIONS <br />SIGNATUREOFAPPLICAN7 DATE <br />CALL FOR INsrt� � i�rn <br />POST ON 25g•g811 <br />JOBSITE 24HRS.BEFOREI:ONSTRUCTION <br />