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CVefC" APPUCAT�ON FOR PUBLIC WORKS PERMIT <br />� tYPa or Print cloetly wilh Ink / <br />PPESS HARD - VOU AFE MAKING COPIES `� 1/�� <br />PUBLIC WORKS � <br />EVERETT, WASNINGTON <br />�OWNER f7AGENT DATE ��� �'�' �-��/ <br />APPLICANT,'FIRM REPRESENTED ��` � � S � /��3%t S _iqJC. <br />PCRMIT NO. . _ _../ <br />BLDG. DEPT. NC.O_��� �� � <br />AODRESS _ 0_�� __S� t• f' UERr %T /}iA/G l(I�CITY EUrr�t�TELEPHONE �'SS�y��r� f <br />HEREBY P.PPLIES FOR PERM�SSION TO /N��7�C c�-S �_ _lN��E �l�nLRL`�� ___ Q�VEw�I `� <br />_ _ _ � _ -----�--/ �-1 -�/ <br />AT THE FOL�OWING LOCA710N I� G��r���U� L S%!�I ;�S "'.'/ / J`/ S7. �, �'�.• <br />Attach five (5) copies of prelimin3ry plan� for proposed work. Draw to scale and show the (ollo�ving a� applicable: <br />' Properry lines and street identity. <br />• Outline and dimensions of e+cisting and <br />proposea structures. <br />' Existing and propos?d utilities. <br />Centerline o� �bu�ting right of way <br />GC�NDITIONS: <br />I, <br />L �� <br />� <br />PUBLI <br />�,�,�< < I< �� ,4�. <br />t� 1\4 (� ll YN (� � �� L' <br />� <br />OC.CN! 1 N(� C�Nt' <br />l�.l b.,,�.+rr ( <br />�tl..l.,��'� -knc%P.\ <br />D.;.� �� �r •, cT i��.� <br />• Topographic changes requiriny cuts and (ills <br />olher than normal foundation. <br />' On-site drainage systems when required. <br />• Erosion control mej�ods when required. <br />�''�Jo arr � / <br />� ��G1 � ,/�� �L _ _ _ <br />sry�iwr�� o� nnN�czn� <br />,. �.,,��.i i, _ ,� .V. , .l , ., li�, 1� 1 <br />' <br />� , <br />� br��«1< «5�_ -l.:� �„6L` t�.c... �t:. <br />'{ti C/..: �♦ J� � N f�' I t. .� � N iq '� � IJ Y ( Y( � R� i '. l <br />1 <br />,.,�v P..b I��_ R,O. w. �.,,.r .�-l„ , <br />�,� i, 1. �.. � I.;�., �.�-� „i, .I ,�,I,� . <br />�, 1�r.�, ,�'cc_L� i �t i� <br />i� <br />���;��� <br />�._ . fif— — ,5 - /�Y b' z <br />F7 VIED C NSTRUCTION OATE <br />RO �y � � � <br />�- -.Lx� ' „�-1- 1�-��. _ /.' <br />�PA VE C NSTqI/ET'�E� DATC <br />PERJIIT IS VALiD F'�R 1 YEAR <br />EXPIRATIOPi <br />ii. �u.L•i.,..n.••J .�.� �� i .,�.I.� .u;r�.��, io nubi nntl envu he�mlcr. <br />Inr t..l� ,�I I �on.Il uu�n �ny ann �m �.mi�:w Inr AamnU�s. rnsl• <br />�-.i�i nsi•s, or causns ol nclion Ihal inny nnsa becausr ol ins�allilirv� <br />.n�n main�onence ol I�a imp�uvemnnl or olher np�l-nl�wny �� � <br />i��.��lo ep�IloA lor BntllUrlher eBreBe tL rc-mow. anm.• iippn ������ �� <br />����•• Ihe C�ty and la repleca publlc pi��i � �. � � � ���' ' � � <br />/hCKN�JJIF�OGE1.SEql1 O�ONOITi�)f�' <br />C� / -���/y(/ <br />/ �IQf/Tl1�HEOF�PPLIGANT I��:,II <br />CALL FOR INSPECTIQN <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORECONSTHUCTION <br />