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� ' rveren <br />APPLICATION FfJF; PUBLIC WOR(i(S PEF£M'I'i <br />� TYOe �r Orinl clnerlY wilh Ink <br />� PRESS HARD - VOU ARE MAKING COPIES � Z. c I� <br />� PUBLIC WORKS PERMIT NO. __ _ �1 <br />I EVERETT, WASHINGTON kiLDG. DEPT. NO.�'�� ��0,2 S�S <br />, ��OWNER ❑ AGENT DATE L- ��i -�= Z- <br />APPUCANT/FIRM REPRESENTED fiillie t:omea Inc. <br />i - -- -- <br />8]G S.E. Everntt Hell May Lvoratt 355-449"s <br />ADDRESS .______ ______ _ __ _._____CITY __.__TELEPHONE <br />Inst ell drivewey aS � W� uE �� ��� vc <br />HEREBY APPLIES FOR PEFiM13SION TO _..___--____ __ ___' P. <br />_ . -- -- _ - -- _ <br />_ -- --- --- ,/ <br />� ATTHE FOLL'JWING LOCATION �r 11"I - I�( _� iit/C '_'• i. ..G ���-�I --77 �! S.W. <br />Attach five (5� copies of preliminary plans (or prop�sed work. Draw to scale and show the (ollowir�g as applicable: <br />• Properiy lines and street identity. • Topographic changes requiring cuts and fills <br />• Outline and dimensions of existing and other than normal foundation. <br />, proposed structures. � On-site drainage systems when req�ired. <br />• Existing and proposed utilitfes. • Erosion control methods when required. <br />• CeMerline of abutting right ot way. • North arrow � <br />��;,, i 1(��/ l( <br />' �SigM1alure ol Appllcenl <br />PUBLIC \�/ORKS PERMIT <br />CONDITIONS: <br />�oot' i�p Q�Ainas (' Nrrrs / d v c.'�GN T�.� //��! on �b e /a 1� <br />A <br />� � <br />�j �i / r <br />�/������ /_"�•� r-, �'.,r ��" O ` <br />��/IPPROVED F017�ONSTRUCTION DATE <br />�.�n� . � z -� � �3 <br />APPROVED AS CONSTR TED DATL <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION �� - � ' - i ` <br />; <br />AC <br />The undersigned owner heroby agrees to hol� and eBve hBrmlee: <br />1110 City OI EvBll!O IIOm BOy BOd 811 CIBImA IOf tl!lIIB(�D6, COlIp, <br />erpenses, or ceuses ol acllon Piel mey erine becaune ol iretelletlon <br />an0 mainlonnnce ol Iho Imprnvemenl or olher np�Pot wny uee <br />horalo apPGod lor and lurthor n7reen lo �emove Bame up'�n nolice <br />Irom Iho Cily anA lo ron�ace nuhlic propehy demapaG ihereby. <br />70N.�LEDGEMkT1T Of CONDITIONS <br />�l(!' 1-tt�(G� <br />SI({iNATUREOFAP�LIC4NT � -�� DATE <br />CALL FOR INSPECTION <br />POST ON 25ft.gg11 <br />JOBSITE p4 HRS. BEFORE CONSTRUCTIi)N <br />� <br />�� <br />� <br />J <br />