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e'� APPLICATION FOR PUBLIC WORKS PERMIT <br />Ty, �� pr pnnl deatly wP� inM <br />PRESS HARD � VOU ARF MANINi� COPIES �' � <br />PUBLIC WOFiKS PFFMIT NO. '�' `�� i <br />EVERETT, WASfiINGTON <br />r � ' f3LDG. DEPL NO. <br />f I OWNER f I AGENT D�TE ��� I� �- <br />APPUCANT/FIRM REPk[SLNTED f��« �S . � '" ` � � <br />ADDRESS �� �: .' r' r c f i Ti , h'!�� ( l�lf f 1�E.71E a <br />_. �. CITY ._ TELEPHONE,��'.�.5-�� �_;,.�. <br />HEfiEBY �PPLIES FOR PERMISSION TO ''��- %I'�LC p�t " �i il.l�Rc7� �l_��.' /rr�. r<_�t�'/ _ <br />� � �� ��' -f S.%✓. - -� ,�rT f,7 <br />AT THE FOLLOWING LOC�TION �� � � � s ' G'�- ������ � �(�� � � � <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the follo+ving as applicable: <br />' Property lines and street identity. • Topoyraphic changes requirinq cuts and fills <br />' Outline and dimensions of existing ar�d other tlian normal f�undaticn. <br />proposed sfructures. • Omsite drainage systems when required. <br />' Ezisting and proposed utilitirs. ' Erosion control methods when required. <br />' Cenlerline of ;abutting nght of w,iy • Norih arrow <br />�:v.i� ���/��' <br />�' sinn���iu�r o� cn�d�,:nm <br />PUBLIC WORKS PERMIT <br />coN�inor��.. <br />� .l \-��, ct�."., ��,_ ,. �� _,.i� li�.'- �_, , . <br />:,, � � <br />r — � L �� i •i .. ,.« . �.�_ �. t �� f .-, . . .� ,- . � . � . . , <br />/ � <br />:tr:2<� �.'-r (,�. .; z: ,�� , . . <br />� <br />. '.� :.�..�—' .-` <br />t_- o <br />APPROVCD F�fi GONSTRUCTION � � DAT[ <br />�. /' L LL� //C / 1—�' <br />APPROVED AS COIfSTf,�FTED ��ATE� <br />PERMIT IS VALIU FOR 1 YEAR <br />EXPIRAYION --=--"'—�-=-- -- ---- <br />. . �. . . � .. , ��� �.�i„ ,.n,.�.. i„ „�nd � nd �avr hn,n,irss <br />�. �„..I 1�. n II ;,�.� �.uU ana nn ��I.ums h i tl�.maUes. cos�s_ <br />���i ���.,i!, w c;�usus o1 ;ii�l�on Ihal may ariso bec.wsx ol inslallnbon <br />.u�d �n;unlnnnnce ol Iho imprnvnmanl or ot�n nph��ol�way usa <br />�.�����lu apo�ieA lor enA lurlher ngrnes In rrmove anmr unon noli,.r <br />i. r.� Ih0 CtlY end 10 �9pInCC public proPrrN �]nma(1�,�1 Ihcirby <br />� ACKNO�VL[DGEIy1�N�-OF CONDITION:, <br />�:7 i ,�,iT i <br />. i�����` � ; ; ��( � <br />$�GNATURt:Of APPLICANT DATE <br />POST ON I CALI FOR INSPECTION <br />259-8811 <br />JOBSITE 24HRS.BEFORECONSTiiUCT10N <br />