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�'�"" APPLICATION FOR PUBLIC W()RKS PERMIT <br />� TrPe or onnl cleerlv wllh Ink <br />PRESS HARD • YOU AhE MAKING COPIES �_'_l� `-. `� <br />PERMIT N0. _ _- __— — <br />PUBLIC WQRKS <br />Y�QWNF.FWA L7IAGENT DATE .�'-l� ��' BLDG. DEPT. NO _— <br />/ � �.. <br />APPLICANT/FIFiM REPRESENTED �_ ��L(S fS �1/G ______ <br />ADDRESSB^uv_��• �=UFKE�_��CC GU� CITY �✓C�t� ._TELEPHONE.3SS�N�FSZ• <br />HEREBY APPLIES FOR PERMISSION TO _�U��L �.5� (�%!�E GON(KETC�_�Qll/t-Ui%F"�___ <br />---- --- -- ���� �� <br />AT THE FOLLOWING LOCATION ��� 1^�^w��"^—�1_�`-/�S— 50�� 7'�_ �t _ S. ��_ <br />Attach five (5) copies of prelirninary plans (or proposed worh. Draw to scale and show the (ollowing as applicable: <br />• Proparty Ifnes and streqt identity. <br />• Ou;line and dimensions o( existing and <br />proposed structures. <br />• Existing and proposed utiliiies. <br />• Centerllne of abuttfng right of way. <br />�_IC <br />• Topographic changes requiring c�:ts and fills <br />other ihan normal toundation. <br />• On-site drainage systems when required. <br />• Erosion control methods when required. <br />PERMI <br />CONDITIONS: <br />.... � �• ��Ut' -,v�J Clrn�.�.,nSC_ �+�w.[.i �lr �.,n��ra.l�r.1`u-. -��r �c��.. <br />'..: .. �• ��N.� c�a�na5e o� �or��.l..,�._ i� <br />i .�_.. . . . . . . .ueC�..( �n( .CINt � Go.�bi'(ue.C�o.. <br />J <br />' : : : : b� b�,���ler. <br />: : : : . �. �.��,s —I�-r,�t����' �,.�� .�.61,� <br />�..... LO � ��Y f.n �— ila. •S �� C � S a., �.J aG <br />4 . . . . . . . � <br />I. . . � . . . r . . . . . <br />� _�.--. . .� t. . .. .. ; _ , :_ i .: . . . . . <br />. . � . . . 1 . � . . . . . . � <br />_��_�/��-- ,S JG �L <br />A�FOVED FOR CONSTRUCTION TE � <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />1�..61�� 1���1+�-u�-w: <br />%; <br />„riH•> 1- be re�.-����,� <br />{��51,��- -� (- -�v„y f:,..-. -�1,�. <br /><-�r'n.�.�l' ��r �1n,�.' <br />ThC unaereigno� ownar hereby agrees lo hold nnd .a��e nermleaa <br />Ihe Clly ol Evarelt Irom nny ena eu cieime lor �ameQee, coele, <br />e.punsee, or ceunee ol eclion 1�et mey arlee beceuee ollnelellaUon <br />Bnd melnlenance ol Ihe Improvamen� or ot�er rlQh4a4w�y uee <br />hBrBto BppliBd lor Bnd lUrl�et Pg�eae b remove e9mB upon n011Ce <br />Irom Ihe Cily and lo repinca pu6lic ��oDetly Cemegad Ihereby. <br />OF�CONDITIONS <br />l.L _ —�_�� 2- <br />:ANT DATE <br />CALL FOR INSPECTION <br />POST ON 259•8811 <br />JOBSITE 24 HRS. BEFORE CONSTHUCTION <br />