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�"e`e" APPLICATION FOR PUBLIC WORKS PERMIT
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<br />PRCSS HARD - YC7 ARE MAKING COPILS pERMIT NO. r^'� �- ��
<br />PUBLIC \NORKS / /Q �/,)
<br />EVERETT WASHINGTON BLDG. DEPT. NO.t�Z /.. -
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<br />�;.0`NNER I I AGENT DATE �%- / ,
<br />APPLICANT/FIRM REPRESENT[D /! �«�-S.� - �n�r�� .� /��� � -- --
<br />�� (- � , �� � r R'� I fl�( '' f���ITY _�G-f r �� ' TEIEPHONE .3SS-�/'� �
<br />ADDRESS _ _ -�-- �
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<br />; �5��« °�� �.(%��jC= (�r i , , �;�-�Ve�7t1 L--
<br />HEREBY APPLIES FOR PERMISSION TO _ -
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<br />i,•, �/;,,, , � ,,,�r-��-So� ,y 5.
<br />AT THE FOLLOWING LOCATION �' ' --
<br />Attar.h five (5) copies of preliminary plans tor proposed work. Draw tu scale and show lhe tollowing as applicable:
<br />• Property lines and street identity.
<br />• Outline and dimensions of existing and
<br />proposed siructures.
<br />• Existing and proposed utilities.
<br />• Cenlerlinr. of abutting rigM ol waY.
<br />CONDIIIONS
<br />• Topographic changes requiring culs anJ fills
<br />other ihan normal foundation.
<br />• Omsile drainage systems �vtien required.
<br />� Erosion control metl,o�is wh�;n rc��uired.
<br />• Norih armw
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<br />� ^� PUSLIC W'ORK
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<br />�YF�D FO CONSTRUCTI(
<br />BV[� S CCN�TR�JCTED
<br />PERMIT IS V
<br />EXPIRATION
<br />_%-//• d t-
<br />. . DATE � ----�
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<br />�DATE
<br />ID FOR 1 YEAR
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<br />PERMST
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<br />Irani Ihe CdY And in rop18[B Oubbc Prc��..rir �Innia9rd In�roby
<br />j ACKNOWL@DGEM�NT OF CONDITIOH`.'�
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<br />SIG�t�YUREOF'�AP�LICANI �DATE- _
<br />CALL FOR It�SPECTION
<br />POST ON 259-8811
<br />JOBSITE 2qHRS.BEFORECONSTRUCTION
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