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�` APPLICATION FOR PUBLIC WUF�KS PERMIT <br />� �YPc a� pnN <:loarly wdh inM <br />PRE55 HARD � YOU ARf MAKING COPI[5 pFRMiT NU. '� `�� �! <br />PUBUC WORI<S <br />EVERETT. WASHINGTON EiLDG. DEPT. NO..� -- %�� � <br />! � OWNER I1 AGENT DATE �- � F� r� � � <br />APPLICANT/FIRMREPRESENTED ��<<�S I-1��r�'� � -�L�� _ _ <br />ADDqFSS � Z% �,. � i (/r �lC il �IJ/JlC_ ���%�`' CITY ��G'��' ! TELEPHONE,=.' � � _//4 � <br />z� _. .. <br />HER[RY APPLIES FOR f'FRMISSION TO _L����'�< . C�J � �ti" �'PF �� _��" �l/[.' `'��� :' _.. __ . <br />C/ � � / - rT � X <br />A7THE��OLLOWWGLOCATION `/�� � 7 -St. S:itJ,___ ��-�.��',���.�-c L� <br />Attach five (51 copies o( preliminary plans for proposed work. Draw to scale and show the followin� as applicable: <br />• Property lines and streel identity. ' Topographic changes requiring cuts and fills <br />' Outline and dimensions of nxistiny and other than normal foundation. <br />nroposed structures. ' On-site drainage systems when required. <br />' Existiny and proposed uti;ities. ' Efosion control methods when required. <br />' Geoterline ol abuttfn�� rir�hl of way ' Nor1}� aSrow , / <br />� '/,/,' c."F-), 1_�. <br />.a <br />1�r,a�uu. ol nVnhrnnl <br />------�----PUBL_il; VI/Oi�iK� PERMiT <br />CONDI?IUNS. <br />. . /� . �fi::';/ i ;�: /� < �1.7 rr� r r. C .J� -.<JI C�_ %��'�Li ''hfl <br />; � <br />LOT' � <br />� , . , _ _i i �.. ���I � �.���.••• I � lin�tf dnd tin r trtlrmlr5s <br />L, .. �� 1�� � u •. . i., . i,�.� au rni�ms lor domapqs. cos�s. <br />��prnsr5.. i�.uues ol aU���n Ihat miy ause bec0u5e ol ingl611ahon <br />nnd mamlennnce ol tno improvomonl or ol�er nghl�o6way us�� <br />n��rol0 nDP��od lor wnU lurlher egrees lo rnmave eama upon nnb• �• <br />�rom Iho Gly xnd lo replace pu0lic nrupunY damnpri R�e•rrny <br />, �., , _.� ' '� �� . u L- _� - � t iL �� ,� <br />APPROVEDFORGONSThUCTION �'� DA�E , , nCKNQWLEDGF.r1ENTOFCONDITIONS <br />( r � � <br />. , i . , . ��i(Ul �����:__ <br />APPROVEO AS CUNSTRUCT�D � DATE � SIGNAYURE OFAPPLICANT DATE <br />PERMI'� IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTI(lN ' <br />259•8811 <br />EXPIRATION =l �/-t-j_ _---__ _._ __._ JOBSITE 24 HRS. BEFORECONSTRUCTION <br />