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everett APPLICATION FOR PUBLIC WORKS PERNIIT <br />� �1Vv ni Vuni clendy wil� ink , <br />PR[SS HAHD - 1'OU ARE MAHING COPIES pEHMIT P'O •/ � 1 <br />PUBLIC WONKS <br />[VERETT,WASHINGTON BLD� �EPT.NO. �'��'� <br />i r�,,>n;: . ..._.— <br />`7 OWNER I.I AGENT DATE � <br />IIi;li. Jor��:; 'nc. <br />APPLICANT/FIHM REPRESENT[0 <br />ADDRESS �.;:.�� _.� . � .���'"ct 7;�11 �•;a; CITYrva_retY <br />HERf=�YAPPLIESFCRPEHMISSIONTO 7i�'��°�1 :��rivo P�ay <br />,.�, r e z ,/�,� -, y al, 5�. S, �n/e <br />AT TH[ FOLLON'INv LOCATION 7 � <br />TELEPHONE ' "-Q�� <br />Attach five (5) copies ol preliminary plans for proposed work. Draw to scale and show lhe (ollowing as applicable: <br />• Property lines ard street identity. ' Topographic changes requiring cuts and fills <br />' OuHine and dimensions of existing and other than normal foundation. <br />proposed structures. ' On-site drainage systems when required. <br />• Existing and proposed utilitie�. • Frosion control methods when required. <br />' Centeillne nl ahuttin� iiqh' cd w.ry ' North arrow � <br />� �. � � <br />_ _. Siynatum nf n�,u���:um <br />y� PUBLIC WORKS PERMIT <br />CONDIiIONS <br />itool iv�� �1r�,,.,�.J� ,,. �� <br />J r. � �' I �` � . <br />. t <br />��. � l �1-1-c"Lc /L NC C�i,�'CL.�LC � <br />�� ti �. �y l��- _='1--� <br />C � . r� -� c �`�' 1 � "-°t ,^ ; �Lf�� LL Z�LG ' . <br />�--> <br />c_ ,�i ��– <br />t <br />i:>/'� � i�.l�1.� <br />i'— <br />hPrROVED FOR CO �TFUCTION� <br />. r�.•rz� _- =I ! �� <br />PERMIT IS VA{_I <br />, <br />EXPIRATION---- <br />��7� i� ' D <br />0 <br />, .. � �.. i. .i�., .�,pr•rs lo hidd 2in�l snve harn�Ir55 <br />� � � i, o , n. ii, .� �;pi�� �II f,Iq11O9 �Of tlemapas, cosla, <br />. � i . ; �.-, .�i � .nu��s ��d ,,, nun :hu1 mBY erlee 6eCeu5e o� Inelalle�lon <br />,.. ���,unlrnnnce ol I��e iml��nvement or ol�er iiph4o4weY u9e <br />!. „ t�. �pphed lar nntl Iwlher egrere lo removo same upon nopr.e <br />.. ❑m CiIY end lo �nplaca pu'dic prnpuiry daniTprd Picreby <br />- _ � . / _. d � .. <br />ATE AGKNO)(ULEDGEMENT�OFCONUITION`� <br />� <br />/ <br />_ — '� . >a.� �-'% 1 .. I f!( � j � ; LrJl�� L (• <br />pqTE $I�'iNATURECIFAPPUGAIJT DA11- <br />1 YEAR <br />CAL� FOR INSPECTION <br />f�OST ON 259•8811 <br />JOBSITE 2q HRS. F3EFORECONSTRUCTION <br />