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�everctt APPLICATION FOR PUBLIC WORKS PERMIT <br />TYPx or print Ueerly wilh Ink <br />PRESS HA9D - YOU ARE MAKING COPIES pERM1T NO. �_��. �__ _ <br />PUBLIC WORKS <br />EVERETT,WASHINGTON <br />�OWNER ❑ AGENT DATE Si�i BLDG. UEPT. NO.— _ <br />y�-Z'- <br />APPLICANT/FIRM REPRESENTED . ��«-S � +""' e�_ _�C—___ _.. <br />ADDRESS 1�1 �o S� -F. E✓�d! ���" W/�"Y CITY E���� _TELEPHONE 3SS�-�J�/5 L <br />HEREBY APPLIES FOR PERMISSION TO i/Vs%�LL o�S� l'�/DE C�O.(K�PpT-�_�,Q/�/G.Z✓/F`� _ <br />ATTHE FOLLOWING LOCATION L�!/� _(/Yra�i�� Ff>c,�c5 �Q/— %5/ fh,sY, .S_E„ <br />Attach five (5) copies of preliminnry plans for proposed work. Draw to scale and show the following as applicable: <br />• Property Ilnes and sireet identity. <br />• Outline and dimenslons of existing ancl <br />proposed structures. <br />� Existing and proposecl utiliUes. <br />' �e�terline of abuttinQ r(ght of way. <br />PUBLIC WORI <br />CONDITIONS: <br />I l, Roof'- fo� drq►naJ� <br />fh� 1 of <br />' Topographic chan��s requiring cuts and fills <br />other than normal foundetion. <br />• On-site drainege systems when required. <br />' E sion conirol methods when required. <br />PERM <br />mNsf be con��lf� <br />, <br />�.::: <br />�,� f�ny da,�q�e nr hreaka9�° � P��bli� R,0,1�! <br />: oec�,cri�3 du� -f-o construc�-ior� m��sf b� <br />rePq�r��L by bi�►Id er. <br />' . 3, l�,b�i's� frqck�d in-� <br />. �onstrtic-f i vr� s;fe_ <br />AP •OV F RD - UC:TIO� D TE�c.�i <br />I_ , �� �=�1-i3j <br />APP�VED AS C STHUGTF_� DATE <br />PERIIAIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />� <br />p��bli'c � n..w. fi-or� th,s <br />�, to clp�n�d up dQi/y, <br />POST ON <br />JOBSITE <br />The nneeraiQnetl owner hereby apieee lo hold nnJ eave hermleec <br />Ina City ol E��arelt irom any ana eu Ueimn lor demeqe4 coste, <br />e�penaee, cr ce�een ol ectlon ihet mey erlae bec�uee of Inatelletlon <br />ane melnlenence ol Ihe Imo�ovemenl or otnor rlpnFol•way usa <br />herelo epPlleO lor en0 lurlher npreae to remove eeme upon nolice <br />Irom Ihe Clly nnA lo replece public properly demeOeA Ihere6v. <br />CONDITIONS <br />CALL FOR INSPECTION <br />259•8811 <br />24 HRS. BEFORE C�:;NSTRUCTION <br />� <br />