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�"e`e" APPLICATION FOR PUBLIC WORKS PERMIT
<br />� TYPc or P�inl cleatlY wd� �nh � .
<br />PRESS NARD � VCU ARE MAKWG COPIES
<br />PEHMIT NO. .. -
<br />PUBIIC WORKS
<br />EVERETf, WASHINGTON BLDG. DEPT. NO.
<br />1`�OWNER 1.)AGENT DATE �.� � �7 ��' .
<br />APPLICAP'T/FIRMREPRESENTED �/����5 :�i�' ''�` �' "���'�' —_
<br />ADDRESS t� �'_ � � ✓/ �' ! ii n�[--L -J '
<br />� �v� CITY � `" ` � �' �� TELEPHONE _.5_`' �' y`'
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<br />HEREBY APPLIES FOR PERMISSION TO _ __ - - i—� - . .___ .—.
<br />AT THE FOLLOWING L(�CnTION �� G�� � ��� �'1 �< < '� %�» ��'' ������ �" �� �•
<br />Attach five (5) copies of preiiminary plans foi proposed work. Draw to scaie and show the tollowing as applicable:
<br />� f'roperty lir,es and street identity.
<br />' Outline and dimensions of existing and
<br />propo;ed structures.
<br />� Existinp and proposed utilities.
<br />' Centerli�;e ol �buUiny right o( way.
<br />CONDITIONS:
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<br />• Toponraphic changes �equiring cuts and lills
<br />other ihan normal foundation.
<br />' On-site drainaye systems when required.
<br />• Erosion control methods when required.
<br />' North arrow
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<br />.. Si9natp�c ol AppLcnnl
<br />PUBLIC WORKS PERMIT
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<br />�� i.� �� � I! ina un�'e�5ipneA nwnei he�ePv aqrnns lo holC nnd 6ave han'-'-
<br />�Ihe Gy of Everelt Irom enY entl nli clelm6 lor tlamaqos. �� '
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<br />���pons. s, or cauae^ u� ncllon �nel mny anea Gecauso cl mslaii r
<br />nnd muinlonnnce ol Ihn improvomanl or olhar nq�4obwn� �.
<br />horoto applietl lor and Iwther eBrees lo remove seme upon ���+ �
<br />hom ihe Glty nn0 �o �ep�nce public propelly damepod Iheiri�;
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<br />A�PROVED FOR GONSTRUCTION _ � : DATE , ACKNOW�EDGLMF�IT GF CONDI7lUNS
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<br />AppRC1pE(Sp$"'CpM�fij?liF;T�-�' UA7G SIGNAiUREOFAP LICA�JT DATE
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<br />PERMIT IS
<br />EXPIRATION
<br />��OR 1 YEAR
<br />POST ON I CALL FOR INSPECTION
<br />259-881 1
<br />JOBSITE 24HRS.BEFORECONSTRUCTION
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