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�;;�1 APPLICATION FOR PUBLIC WORKS PERMIT <br />iYVc nr pnni r.lcai:y ��Ih in4 <br />+1� PRESS HARD � YOU ARF MAKING COPIES �.,� �>, <br />PENMII NO. � �� ", <br />PU�LIC WOFKS <br />EVERETT, WASI-�INGTON �� BLDG. DEPT. NO. <br />IIOWNEH I�IAGENi DATE 1 ��, ' <br />APPLICANT!1=1RM REPHESEN7'[D �I(«.�5..�-F'���� -' - ���`��- <br />- �-r.�4y - <br />ADORESS L'�' :'� c�,r- G r 77 /%%/J!L -- — CITY �� �� � TELEPHONE�:�''r "` <br />HERL�Y APPLIES FGF PERMISSION TO �/USIii''C �� �� /(n�// f-7� �� <br />- - - - L'�'Jc�i.U1� ,' - �--- ---- <br />L/ //+. <br />l�.I TH[ PO'_LOWING LOCATON "/%/ ��� — '� � S, �/^ <br />�!`r - . <br />(i ! , , <! - . . . <br />Attach live• (5) cooies ot preliminary plans ioi propcsed work. Oraw to scale and show the followirg as applicable: <br />• Proparty lines and street identiry. • Topographic changes requiring c�ts and fills <br />• Outline and dimensions of existing and olhei than normal foundalion. <br />proposed struclures. ' On site draina5e systems whe�i required. <br />' Existing and proposed uiilities. • Erosion :ontrol methods whe.i required. <br />' Centertine of abuttiny riyht of way ' Norih arrow / i <br />; , ,'�: �� <br />--� � <br />tiiqnnwin nl AppLcanl <br />PUBLIC VI�'ORKS PERMIT <br />GONDITIONS. <br />�\L,11.J \ �l �/ C1.I L11�1 V'`` IIIII Jl� :il. LJv� <br />J�(.�-,�C :')!_.%'; � '^�% 1 �� ���i�( i / <br />Rf�, : c�cc., _%f'/Gp <br />�!���.� a�7 J-: ,�• �. <br />���',}s .,c �� � � �- ;. <br />:!.:; [_ f=`/'�•� {i <br />;., C:.G �'.�'. f-c- <br />F �-� �i.�'Uc�• , <br />,,'�L ��-`�,.�,/�� �� ( . 4 �; ,. 5' <br />.:i:'" ', v, � 7 r <br />" -' .' ��=�'� __ l_a. � <br />AP�fiOGEF FOF �NSTRUCTION D�:'F <br />APi'ROVCD AS CUNSTRUCT. ED DAT[ <br />PERMIi IS VALID FOR 1 YEAR <br />EXPIRATI�IN �===-'- <br />%�' Cf/E.•" <br />Iq cd�• ,rJ u�J uhnoi �u�irb� :�y�rr. lo hnP: anA baw� huru�in.,- <br />IIIP Ci�y UI [VOICI� �lOT 8fly 8�U P.II f.IB1f116 IOf Q9T8•)29. Co'.�•�', <br />I��pCfi5f9. O� ClUSP,4 01 0CI1011 �h3� lli0y Pfi68 bBCBuSB OI .�SlBllal��'�� <br />antl mqinier'.xnce ol Ihe �mprovemsnl oi olher nghl-nl�way �� � <br />hurelo applied lor anA lunher nUreee b removr rnmP upo� ��. �' �� <br />Imm Iha GiIY nn0 In �ePlete puhlic prrr-..i, .�.v.�.,r•.� ^�� �� ., <br />� AC�NOWLEDGEMENTOFCONDIiION�� <br />i i ' ,, i <br />i i/„ ��(i � '� �I: i <br />���SIG�PI�TUREOFAPP�CNJT ���'��I <br />CALL FOR INSPFCTION <br />POST ON 259.gg� � <br />JOBSITE 24 HRS. BEFORECONSTRUCTION <br />