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"'°""� APPLICATION FOR PUBLIC WORKS PERMIT <br />� Type or prin� cleerly with Ink O <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. $ 1/� o <br />PUBLIC WORKS <br />EVEFETT, WASHINGTON BLDG. DEPT. NO.�� /�6.3� y_ <br />tJ OWNER ❑ AGENT DATE v- �� 1_- �'" - <br />APPLICANT/FIRMREPRESENTED _��<<� _����i -`.'�--��'� �e= <br />ADDRESS i��--., r". �; �/'r �i /i�/i! C G�%�`/ CIN � vr �'r r7 _TELEPHONE_J S S `����y <br />HEREBY APPUES FOR PERMISSION TO �/t!S I//r ( -: �_ ((�/��F �/ �_'_ �� •'� ��h'ilir rd��_/ <br />ATTHEFOLLOWIkGLOCATION <<�---,�----«_���'F•<'�'_r'�_;/'(� =�%U� %Y�� 5�• �•LU• <br />llttach five (5) copfes o( preliminary plans for propo��ed work. Draw to scale and show the following as applicable: <br />' Property Iines and street identity. • Topographic changes requiring cuts and fills <br />' Outline and dimensfons of existing an6 other than normal foundation. <br />proposed structures. ' On-site drainage systems when requlred. <br />' Existing end proposed utilities. ` Erosion control ethods when required. <br />• Cpnterline o( abuttlng right of way. �` Norihja�jOw /� / <br />/ � f L- <br />� � - � S nBlure ol Appllcenf <br />PUBLIC �lUORKS PERMIT <br />CONDITIONS: <br />, , �oo� --�(� c�r r,;,a��t w,��s+- bE <br />I f "; ;;" a� �l�e I��—. <br />� i : ._:_: : : : : . : : _ <br />;.... . <br />;...:: : <br />` :_: : . __ 1 : : . ; . . . : . . ; . <br />i__.._.... . . .... .. . <br />.- <br />;:::. ; <br />;...... . <br />, ... ............. . <br />' . �� _ `,.��.._ - � //- �" L <br />PERMIT IS <br />EXPIRATION <br />--z. _-� _t <br />� DATE <br />�D FOF�' 1 YEAR <br />�::i-�j <br />c_�c, ., i�rn � �e�� <br />Ino undvimgned owner here�y egrees lo hDld and eeve hBrmleee <br />Ihe Cily ol Eveiell trom any ana eu cie�me lor demepa4 «cte, <br />e.OBncPe, 0� CnuSB9 OI BCIiOn IhBI mey erieB beCeueB 01 Inelalh�lOn <br />end melnlenenta of ihe Improvemenl or Ot�er NO�I�ol�wey u�e <br />hereto applieA for and lur�her epreee lo remove seme u0nn nollce <br />hom thn Clty one lo ra0�ece puUl�c pmpeAy dame9ed t�oraby. <br />l' i <br />j � ACKN07rvLF�OGEMENt Of,CONDITIONS <br />l , , <br />_ , �'�rr� .. ;r,,� ,� 3 „� .� — <br />SIGNATURE OF APPLjCANT bATE <br />CALL FOR INSPECTIGN <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTAUCTION <br />� <br />I <br />.J <br />