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�everen APPLICATION FOR PUBLIC WORKS PERMIT <br />rroe or print cluerly wlln Ink / <br />PRESS HARD - YOU AAE MAKIN6 COPIES pERM1T NO. �'i "� S�`' <br />PUBLIC WORKS — <br />EVERETT, WASHINGTON BLDG. DEPT. NO.�� � <br />�OWNE'i ❑ AGENT DATE �' _=1,-�af � <br />APPLICANT/FIRM REPFESENTED ���_���_�L��—���� S__��'� �-_______ ____ __ <br />ADDRESS ��_ J' ��t �l� %/ //i/��� l�'�A CITY t'��F�t 7% TELEPHONE✓��= y�F� <br />HEREBY APPUE5 FOF PERMISSION TO ��5���«" �S_� ��/ If� c!1'i�iG�! %7-_�'%!�l=1���`� _ <br />AT THE FOLLOWING LOCATION ��'! 1���� ��,� �n l�_`_�����,"7�I %S r�/n� J, Lt/' <br />Attach five (5) copies of preliminary plens for proposed work. Draw lo scale and show tne following as appHcable: <br />" Property lines and street identlty. <br />" Outline and dimensions of existing ami <br />proposed structuros. <br />' Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />PUBLI <br />' Topogrophic changes requiring cuts and (ills <br />other than normal (oundalion. <br />` On•site drainage systems when reyuired. <br />' Erosion control methode when required. <br />' • Noi} h errow / <br />//�/,�//� `//�l�Cl��.�� <br />PERM <br />CONDITIONS: <br />� �, �� n <br />�• �f ee� - i3e �+ eciSrw�e..i- ctreo. io Ho'�' -�� lor r�rar�Y <br />� . ��--� (� �ra,..�..�c «�.t�4- bG tc,.,iv..11r� o.� �l.e �o�-' <br />: 3,' � •� � � b e. l� � -}.� P 6►' 2.0. �„ . ., C�., .-, ., <br />ti a.�+u c'. a,� r � ci c .a �a. <br />ciK� �o Gon��1-rKc-i,�.. .,•�K�+ bc �e�n�r�.� b,I b.,,{��� � <br />� �e6��� —i-r�..�1c�� i,.�v ��bGc. R.o.w. �w..-. -1-�.�� <br />. . . _. . . . . . . duKS�ruc�;o�+ z�i�' �i io 6•: C�rcr..�.� � c±a�l� . <br />- « `�1 �, l03 <br />APPRO D AS CONSTR C ED � DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />L_ <br />POST ON <br />JOBSITE <br />The undeieigne0 ownnr herehy ngroee to holA end eeve harmlaes <br />Iha Ci1y ol Everetl nom nny eno eu cieime lor demepee, con�e, <br />e.penses, or cauaea ol e:tion Ihnl mey erlee beceune ol inslelletlon <br />end meintenence ol I�a improvemenl or olher tlphbol-wey ueo <br />narelo eppliotl lor and lurther apreee lo remove eame upon nollce <br />Irom Ihb Clty Bn0 lo replace pubhc property demBDBA Iherxby. <br />/LE.DGE NT F CONDITIONS <br />��� ' ( �� J � _ ,) , 1 <br />E FA�PLICANT DATE <br />CALL FOR INSPECTION <br />259•8611 <br />24 HRS. BEFORE CONSTRUCTION <br />u <br />�l <br />J <br />�' <br />