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r <br />r <br />� APPLICATION FOR PUBLIC WORKS PERMIT <br />x TY{�n o� p�ini � IeStlY wr h mM � . <br />PRESS HARD � VOU AHE MAKING COPIES pERM1T NO. 'a~ ��`�--- <br />I� PUBIIC WORKS <br />E�V"�ERETT. WASHINGTOP! ��_ �_, �� � <br />t7•VWNER I1 AGENT DAiE / <br />� S ��/r" � ' �J L <br />i <br />f / <br />BLDG. DEPT. NO. � �_' �`� � '� <br />APPUCANT/FIRM fiEPRESLNTED / �<< � - " � � � - - <br />t� (� G f ������� '! �r�I�( GUA% CITY � ��f ��� �' .TELEPHONE.'��C y�l�l- <br />ADDRESS C". .J' --- � <br />HEREBY APPLIES FOR PERMISSION TO �A�� ���� � s �-�r/���r--��'�'��r �� . %�F� ��� <<��` % - <br />l�r_ /�/o l/r"�E'ArF,II' E"til i� J _-�-. _ ,.� ri ,, �; „!/ ---- <br />AT THE FOLLOWING LOCATION . -- -- -- - -- <br />A;tach five (5) copies ol preliminary plans for proposed work. Oraw to scale and show the lollowing as applicable: <br />• Property lines and slreel identiry. • Topopraphic changes requiring cuts and fills <br />• Outline and dimensions of existing and . On-shte dhaina�e syslems when required. <br />proposed siructures. <br />• Existing and proposed utilities. • Erosion controy methods when requlred. <br />• Cenlerline of abutting right ol way. ��rih�rrow, � j <br />CONDITIGNS: <br />i � � �pnnlu�e o� aao�iient. ..- <br />BLIC W�R <br />,(' � - T.'/'' iOit� ., ;��'<=.= il/;.��,— ��.�- �.�ri� <br />-,��< < . , �J <br />C� �- <br />U /�) 7/�f.- � l T. <br />�ii�Y" i%/`1i7%f�Gc' c^iC .n'.rr.��f��,r T.; �'«�</c. <br />. <br />� c', tJ. c�r��,l-�JG r7c. r� �vh�J'i�a�irc� i�j'r•J'%"" <br />' �:iic �O� :C" <br />�,^r-- ,(:�� f�„<F �O .cTy � • <br />�iJTa %�r�'4ir � . c"• �J. <br />; � . �JE,6'�'J' �.!''`k'("� <br />. . ' /��'Y7J % �•'`�, � 1,7:1J� �C`(' �i .. - � .S .'Ti �%iJ� _' .n^ _ <br />, � (�",.�� 1.1_J i%� ��"�f''! /; <br />. Thc un�msiyne0 ownnr he�eby ngreos la holU ene eeve he�mlens <br />IhE Cily 01 EvP.fCII 110111 OOy 9nO 811 CIB�T! IOI CBIIIlQ03. COl16, <br />cipen6es. or coufee ol eclion IFnt mxy eKae becauee ol Inetellalion <br />und meinlnnence a� Ihe Impwvan�enl or ol�e� ��q�bol�way uee <br />' �orelo appliad lo� anA lurlhe� pgreee lo ramove eame upon nolice <br />Irom Ihn Cny entl lo �eplaco public pioOertY 4ems0ed I�ereby. <br />:� �" /� f <br />c�_ `% �r " r'�^i_ <br />' _ �' • �. . DATE <br />AP�IiOVED FOR � ON�RU /N � � <br />C fr �%�/�•�'� <br />�--_-- �i �/' <br />� PROVED AS C S RUG7ED DAT[ <br />PERMIT I�u VALID FOR 1 YEAR <br />L -; : /..; c��' <br />EXPIRATION — <br />L <br />ACKNOV�LEDGEMENTOFCONDITIUNS � <br />�- ;� „� � �1�� (i, �'� � �' _- <br />SIGNATURGO�A�PI/ANi DATE <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />J08SITE 24 HRS. BEFORE CONSTRUCTION <br />� <br />0 <br />'} <br />,� <br />J <br />J <br />