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. .' ; , <br />e°e'°" A'PPLICATION FOR PUBLIC WORKS PERMIT '� <br />�� TyPo or Prinl Uoerly wilh Ink ��/ '— <br />PREFiS HARD - YOU ARE MAKING COPIES '` <br />PERMIT NO. —�-- - <br />PUBLIC WORKS p ��, � <br />EVEREIT, WASHINGTON BLOG. DEPT. NO. p_'2i _� v-�sC.�% <br />I� OWNER ❑ AGENT DATE � I.//- �� <br />APPLICANT/FIRMREPRESENTED ���_��S ��L'illC`> _1�UG _ __ __ <br />_ �q r <br />AODRESS ` ' E (—'_�.'�._L�' /—�i��`I�L �vA /..CITY l L�t /I! _�. .TELEPHONE � ` S �IU ir_ <br />, HEREBY APPLIES FOR PERMISSION TO �NS���< < '_� � --- --� -���� E-- `-- --`�\h � v� ��Ay <br />-------------- - <br />ATTHEFOLLOWINGLOCATION �0�_g�� u��n�rnlc rj���-SO.3 %�� � S�W- _ <br />Attach five (5) coples of proliminary plans for proposed work Draw to scale and show the followi�iN as applicablc.: <br />• Property Iines and sireet identity. <br />• OuUine and dimen�ions of existing and <br />i proposed slructurzs. <br />i • Existlng and proposed utilitles. <br />, ` Centerline o( abuttiny right of way. <br />CONDITIONS; <br />. � I I I 1 /� I, ` o-i-, <br />., .. �. ,�DO7' -��D�7 Qf�a�.�a�C Yvi uSi- tla ro.� "lfo���.Y' On i� � <br />z �� ,� � .� �.., o«��,.,� <br />.. c;�w�aJe oi b�calaye� io 1�..61 Q'yl,i� �- <br />; �cio -k.. car��wc��o., w,,.�1- be ���a,..�i b b,���rr. <br />. . . 3. ,.JCVfIS �faC��y Ih.�o 11NS�i� R��:tT -0t • �vn-� ,-�vr��J�l��S CONSif��c �,�., <br />I f • <br />. . . . . . ���G IS. �1� %C C�('U.� n.� H,`J ciU.�� . <br />:. �o j�'�R,�n� �T Ex I�l eC�-1� � J <br />�oUtJ�T'b�1 Pfa1Z.T1ALL_� CO��LC-.TCi� • <br />�� <br />� Topographic changes requiring cuts end fills <br />other than normal foundetion. <br />• On-site drainage systems when roquired. <br />`_Erosion control m thods when required. <br />�� • North �rro�A <br />1 - <br />\ ,�L� � / � <br />'- ' -- ---- <br />_ `-; sl alum ol Avclir.anl <br />PER <br />Nn o�- ���y �2«. <br />r � <br />P�l �" 3 Zz � 8�j <br />Ihe unders�qnod ownei hnreby nyrees In nold and sPve �ermlaea <br />Ihu Gty ol Everelt v�m any nno nu umme lor deme0ee, toels. <br />e�pensas. •�r ceusen ul ecllon ihel mny adeo beceuee of Inetalletlo� <br />. anE melnlennnce oi Ihn improvamant or other rlphl�o4way u6e <br />heralo ep���etl lar eno lurlher xgmxs lo remove eeme upon nollce <br />1 Ih CII �nd Ic repinca publlc property damaqetl ihereDy. <br />� rom o y <br />.'���1�6" /� l.�e'�� 3 � 1 � � z _ <br />VE�FOR QNSTRUCTION DATE I ACKNOWLED6EMENTOFICONDI710NS <br />r � � �� � <br />� :. � � � (; 1(•� �`�''< L — <br />=--� 1- _. _ — <br />� APPROVEDASCON37RUCTED - DATE - SIGIJA�'UREOFAPPLCAN7� DA'F <br />u <br />PERMIT IS VALIU FOR 1 YEAR <br />EXPIRATION � � I F j <br />CALL FOR If�SPEc 1 wn <br />POST ON 259-8811 <br />JOBSITE 24HRS.F3EFORECONSTRUCTION <br />