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^_�•err�t qppLICATION FOR PUBLIC WURKS PERMIT <br />� 1YVr a pnn� rlrady wJ� ink . <br />PHf SS IIANO � YOU ARE MAKING COPI[5 pERM1T NO. ` .' • <br />PUBLIC WORKS <br />EVERETT. WASHING70N 9LDG. DEPT. NO. �� '� <br />:{��OWNEH IAGENT DATE -��"�"'��:' �- � �����` <br />APPLICANT/i=1RM REPRESENlED ��illis lioa�.r c lr,c. <br />ADDRESS � '�-�� .;.! . :�.",Y.�. t�all t;�a:� CITY '.v„i��tr <br />HER[[�Y APPLIES FOR PERMISSION TO � ne-tall df:'���','•`-'• <br />4 4 4 :' <br />TELEPHONE _.__ <br />AT THE F(JLLOWING LOCATION I-" � '� 1 � �`� I � `I } � � � � I S,�/�%�. <br />Attach tive (5) copies ol preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />' Property lines and street identity. <br />' Oulline and dimensions of existiny and <br />proposed siruclures. <br />' Existing and proposed utilities. <br />' Centerlinr, o( abutting right of way. <br />GONDITIVNS. <br />�. <br />z <br />3 <br />� <br />_s <br />�. � <br />��:' , � <br />' Topographic changes requiring cuts and fill, <br />other Uian normal foundation. <br />' On site drainage systerns when required. <br />• Erosion control methods when required. <br />• North arrow <br />i <br />i.` ;; i L. - <br />� � � iu��alpfe alApphr,anl <br />PU��IC WORKS PERMIT <br />t �._. , ` i _` ( :. . � . � � t �� '-'. �. t , � �.... 1 � � C- �. .. � <br />'it�� �' ICJ� <br />�hy � � <br />IJ r� G� �-r�' «- n F v►� <br />�>>J�cc.��P ��D <br />:3�� n�A�►� �.�►�� �R� � <br />�� � ��=�-R ��� <<-�,�s f/<< �; rt� <br />! � . ••; i-. . <br />q1�P O ED Fi�R CON3TRUCTION <br />APPROVED AS CONSTRUCTL[] <br />✓��,��f � ' �t,. <br />`J'� J <br />� �s� <br />nnre <br />>�-r� n r r� � u ati t <br />-siD6�R�v_ ��� ��,-r�rN ���;��;L�i�k <br />7�' D/�'/� 7r' ; ,c'�/'C--�' T, <br />� <br />� ) <br />� <br />Ilu� u,ob•r..y.�.i.�: n,�n�, o�.,����� nyny� � 6. tinl�t :Intl �avr hannlr•.s <br />Ihe Gty ol Evcrutt Imm nny ana al� <laims Inr tlamaBes, cosls. <br />C�pB�5�8, Of UIlISBB OI LCIIO� Il.fli OiBy BII50 ABCBJfB OI ip6lAllqliO� <br />P�d f110��ICI1flfICC OI 1hC improvumunl O� n��rr nqhb0l-w�y u5c <br />h1!relo ap�hed lor entl lutlhel xpreBe In i�����,.�i� �,��mr uVan nubtu <br />Irom tho UIY ond lo replxce Puhlie P'�n,•^�v ������'��]^�� '�hnre�hy <br />.. � 04(f ___ . <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIAATIQN - - <br />/� ACK�JOyVLE <br />1 <br />i l�i.� <br />SIGNATURE <br />l <br />OF CONDITION.`s <br />U.4iE <br />CALL FOR ItVSPECTivri <br />POST ON 259•8811 <br />JOSSITE 24 HRS. BEF'OF`ECON51'RUCTfON <br />