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�•""` APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYDe or Diinl Clearty with Ink <br />PR�-^S HAHO • YOU ARE MAKINr, cnaiFc nji�a � <br />PUBLIC WORKS <br />EVERETT,WASHINGTON <br />i ,�,OWNER ❑AGENT DATE ��- ��'_- `? <br />APPUCANT/FIPM REPRESENTED '�—� � ____�'� �` -' i "�` _ <br />ADDRESSL ��� `' � `��� ��—'� m��� ���� _CITY <br />PERMIT N0. ___ � <br />BLDG. DEPT. NO. �i��J�� <br />�Cf[�/ TELEPHONE "��S�y��%�_ <br />HEREB�"APPLIESFORPERMISSIONTO ��'�?'/r�t ��S',c�_/� .l�v. ['<=7'-_,r;1��'�. <br />— �--/� <br />AT THE FOLLOWING LOCATION ��'=�� ��-� v_�_S�N7c''- ��,� D'%� – 37. S, GU, _ <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following as epplicable: <br />• Property lines and street identity. <br />• Outline and dimensions of existing and <br />proposed struCtures. <br />' Ezistinp and proposed utilities. <br />' Centerline o( abutting right ot way. <br />` Topographic changes requiring cuts and tills <br />other then normal founda'ion. <br />' On•site drainage systems when required. <br />• Erosion control methods when required. <br />i' Narth arrow % � <br />��'J.� �t�;(7/ ./ <br />� <br />- - <br />natam nl AppLcant <br />PERMIT <br />CONDITIONS: <br />, . . . . .� � Il /PYn • i.X'/f,I fosrm�« / .r.�a �r no% � �K C�rer�c.1�'� <br />� . � . � . �. � .%C�liC w •�s/ -irAe�/.Y �nfp �i.6�t A�G✓ // �" C�Pa.nr.-� <br />l �. . . . . . . , . . Ie�% �/?� � . . . � <br />..... :j� . �9��i� w.. / i7 iiJ�t,.�j. b�C •7�+ i!f!w. i r// ll.� n. r✓ t � /�• i/tc K'��.� <br />: :_: : r�w�.1� ��. �l,�� pb�.�/' <br />. . . . . � � �!!w �� .?+v F - �� (//?r �r� o t H� '�/. /�7 �i <br />. . . . � <br />; - .r . /JA / <br />�. ✓v��' lvr.dr�,fr.-�,�r va�v� fu. �� ..+.c/ f•�a�e <br />�. <br />. _ �_.�.�.._ ;_.__ . ..__--1 ---�--_ <br />��� �j p7��'f"3 <br />OVED FOR C TRI�ATE <br />/ APPRO E� A��N3 U EO DA E� <br />�-- <br />PERMIT IS VALID FOR 1 YEAR � <br />E;KPI RATION - <br />The unAarsi{�rs� ownnr hereby agroan lo holE end eave hermleae <br />Ihe Ci�y ol Everell tron any nna en GIp�m6 10� dcmnqae, coete, <br />e�pensea, nr ceueae oi ecllon Ih,il mny erina �eceune,:i Inetelletlon <br />�md melntanunce of the ImOroremenl or other rlphPol�wey use <br />�eroto epPlied br end lurther epieee lo �emova aame u0on noticc <br />Irom Ihe Clty and to re0�ace publlc propetly Aameped tAeraby. <br />�-,�L��—�c?-- _ �•-7 Z.:f�- <br />s� +A�E OF AP ICANT DATE � <br />Pt7ST ON CALL FOR INSPECTIOM <br />259•8811 <br />,JOBSITE 24HRS.BEFORECONSTRIICTION <br />