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� <br />r <br />r <br />L <br />L <br />t_ <br />`""°" APPLICATION FOR PUBLIC WORKS PERII�IT <br />� TYVe Or Prml c'ePrly with Ink ry� __— __"_ <br />PRESS HFRD - VOU ARE MAKING COPIES pERM1T NO. Q^� 13 - <br />PUBLIC WORKS d <br />EVERETT, WASHINGTON �� ��by� BLDG. DEPT. t�0. r� _��.��'.4 <br />�OWNER ❑ AGENT DATE . . - <br />APPLICAN7/FIHMREPRESENTED ��Gl-lS �lYJES �-.v'L. . - <br />ADDRESS �2�0_S� G�_E✓�-RE� MAtL---_L(J�y-- �;TY ���' �r .TELEPHONE 3SS�y <br />HEREBY APPLIES FOR PERMISSION TO ���A�—a S/-- ���E .�GS1��Ct%�� �� Ut��"� <br />. .._._._-- - � - ----- - � -- � - _._ <br />ATTHEFOLLOWINGLOCATION �r /_YL (�E�P/ILEN� CS��T=S�__�r,�������_�-S.��L <br />Attach five (5) copies of preliminary plans tor proposed work Draw to scale and show the following es applicable: <br />• Proporty lines and street identlt�� <br />• Outline and d�mensions ot existi .g and <br />proposed structures. <br />• Ezislinp and �roposed utilities. <br />• Centerline of abutting right of way. <br />• Topogrephic changes requ�ring cuts and fills <br />other than normal foundation. <br />• On-site drainage systems when required. <br />• Erosion conlrol melhods when required. <br />or i arrow / � <br />�%�qp�r <br />/ (�_ 1' ---------- <br />� J —"--- ipr�(wre ol Ao icent <br />C WORjC;S PER <br />CONDITIONS: <br />/, ,�oof= �� �rr�ncy�. r�ws t be con��rolled on the /of <br />a� Any d�mqye �r <br />pcourin� G�'y� <br />r�p q�r�ed.. by <br />br��ka3e, fa Pc�bl�'c �P, o, i�! <br />fo avns tr�+r.ti on mus t b� <br />hc� i l d �r, <br />� O�br� s-�-rArl��e.�C ►nt� p��blic R, o, �v. from <br />fhis eohstruc}-io� sit� is fo b� cl�c,nP�.. <br />up daily, <br />. . narminss <br />PERMIT I.�i VALID <br />E:(PIRATION <br />1 <br />� � � <br />� <br />T�e u���eieipne0 ownei heraby epreen lo �old entl savo <br />t�e C�dy ol Everell trom eny ana ail cieim� lor tlemepee, co�IL <br />r.penaes. or cauae� ol eclion I�el mey uUe Eecauw ol ln���llelbn <br />enE memtanencn o� I�e ImO�orement or ot�er nOh4obw�y uee <br />�e�olo npplieC 10� !n� lurt�e� �9roee lo �emove umn upon nollce <br />liom �he Cily nnA b re01ocB Oubllc prouertY d�mepea Inereby. <br />AGKNOWL Jj,'DGEMEyT�UF CONDITIONS <br />/,` • �G � `/ �' �� _ <br />SIGNA�UREOFAGPLI�NT - OATE <br />CALL FOR INSPECTION <br />PdST ON 259•8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />� <br />� <br />�1 <br />J <br />J <br />-� <br />