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�"'� APPLICATION FOR FUBLIC WORKS PERMIT <br />Type a prinl cle�Ny wll� Ink <br />PRES9 HARD • YOU ARE MAKINO COPIES pERM1T NO. <br />PUBLIC WORKS <br />EVEfiETT, WASHINGTON q BLDG. OEPT. NO. � 4� <br />09 OWNER O AGENT DATE �- o` �-�/ <br />APPLICANT/FIRM REPRESENTED � � � — <br />ADDRESS �S � O I /ri �~ Q� CITV ✓ l � �TELEPHONEJ.?�'� �'�7 <br />HEREBY APPLIES FOR PERMISSION TO ,�S ¢. ��c i s/�r 5 .O v� Y�[ vr�,a v <br />ATTNEFOLLOWIN6LOCATION ����� %�9T� s� ��ey1/� 1✓�i� <br />Attech five (5) coples of preliminary plans tor proposed work Drew to scale end show the following as appllceble: <br />• Prope�ty Iinea and atreet Identity. <br />• Outline and dimenaions of existing end <br />proposed structurea. <br />• Exlstlng end proposed utllitlea. <br />• Centerline of abutting right of way. <br />CONpITIONS; . . . <br />�... . <br />i . ... . . . , ;�RJP .tli�l.� �O/�1' lnr <br />I � <br />�(Jy � •i-{� � r� �<� .l <br />---: : . . : � ���`� L . <br />�� �L I <br />� <br />_:_::::_:,... �,ti`'.I,��rl <br />..... ��� 2"'� � <br />._:_: ;:: : : �I m�. <br />, <br />�...... . . <br />DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />• Topographic changes requlring cuts end fills <br />other then normal foundatlon. <br />• On-site drefnege systems when requlred. <br />• Erosion control methods when requlred. <br />• North arrow , i <br />I�L <br />�,� <br />��l <br />/ <br />y�t dr��t wa� <br />�-Q _ W <br />T�n unGe�niQneO owner �ereby e0�eee lo holC end esve �s�mlees <br />IAe Ciry ol Ereretl vom eny �na an culme lor O�m�pe0. coe10. <br />e.penael, or c�wea ol ectlon �n�l m�y ui�e bec�u�e ol In�idl�llon <br />�n0 melnten�nce ol I�e Imp�ovemenl o� ol�er riphl�al�w�y u�e <br />here�o �p01ie01o� �nd lurther �pree� lo remove ume upon nolice <br />Imm the Cuy �nE lo re0l�ce vubllc o�openy E�m�petl Ihere6y. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />/ SIGNATUREOFAPPLICANT DATE <br />CALL FOR INSPECTION <br />POST ON 259•8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />