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evi•rett APPLICATION FOR PUBLIC WORKS P�RMIT <br />� TY�c or Onnt clearly wilh mk <br />PRESS HARD � VOU ARE MAKING COPIES 5'�.��.} � 1 � <br />PtRM1T NO. <br />F'UBLIC WONKS / <br />``E�'VERETT. WASHINGTON BLDG. DEPT. NO. �•�! �L� Y� <br />N OWNER 17 AGENT DAT�E �C ,% J•d!- <br />/ � J <br />APPLICANT/FIRM REPRESENTED // ' � � � �' y �'�� � � '�n��� � � � <br />ADDRESS�S1�• S.C� C L'c'!<'t � �/1r)ct !C'Ry . _ ... <br />HEREBY APPLIES FOF PERMISSION TO /ti�S/�« �5�� <br />CITY � ��� k�� � . TELEPHONEJ�_t_�yy�� /__ <br />CC�i�� (l.�i/<'r 1[- ��.c'n., �.����(/ <br />ATTHE fOLLOWING LOCATION��/ /��/ �c ��kclC." C�S��1�1 �— 1 U`� �3f� S�".. rJ,Lv,. � <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />• Property line� and street identity. <br />' Outline and dimensions of exis'.ing and <br />propased slructures. <br />• Existing and proposed utilities. <br />' Centerline ��I abutting riyM of way. <br />CONDITIONS: <br />• Topugraphic changes requi, �g cuts and fllls <br />other than normal foundation. <br />• Oi.�site drainage systems when required. <br />' osion control/� ethods when required. <br />• No n.arrow , / % <br />P�16LIC WOaKS PE <br />elure ol ApP��canl <br />n /� / <br />� C� r�r.�. •�'ri i c'as r�-M v.. f a r en /J nc I" p'�s ��� c�lc�r. �. � <br />2. /Y00/'- � �//+��•>a% t' iy�s F "C C7J�o�17��/r✓/ rw �r-/�P ���n�� <br />� v � /IV � J � i C <br />�s <� 6 �. a /% «%0 ,,� ���n. ,; ��„ /31 <br />3. �/Jy [/l,�rndtL ��t. �!!J/4 �/V OCY(I�'/l� �(j,1� OUHj,�'s•�Jlro.w <br />�w.,,� 6e � i-ro��i�.� li, �av���i- <br />/ �rs��ij �'2rr,F�.l%..�;� �6/,c .P/� , r��.� ds%r s„/c. <br />ir � h� c%...,��� c�y ,��..;� <br />� �/f�/ / , % / <br />� � JG��'�' �"i��-d3- sl�,.ic e v�r��e �ro,4 � ,��c� �t f�-nt�P, <br />�_�s� �� 1�L <br />RUC I N GATE <br />�.P, C _ ��- /�-�� <br />UCTED � DATE <br />PERMIT IS VALID FOR 1 YFAR <br />EXPIRATION <br />POST ON <br />JOBSITE <br />in�. �.ndrrs�9ne�1 o+nrr heirby Agrens lo bold 0n0 98ve hBrmle!! <br />Ihe Cily ol Eve�eli �rom Bny en0 01i Cleim! 10� demepee, eutls, <br />e�pe�5C5. OI C1IUSCE OI OCIiO� IhBI T8Y Bfi6B DBLHJlB OI IOlIiIlPllpO <br />antl meinlonence nl �he Improvement o� ot�er rlp�l'ol'wBy u!e <br />�orelo Bpplied lor B�tl lurlhar BpreBe 10 femOve eRme u0on no11eB <br />Iwm the C�ty and lo replece public property demeped IherBhy. <br />��L L� GEM T OF CONOITIONS <br />ti �L--- �Y/�' z- <br />IREOFAPP�CANT DAi <br />CALL FOR INSPECTION <br />259-8811 <br />24 HRS. BEFORECOPISTRUCTION <br />u <br />