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everett �ppLICATION FOR PUBLIC WORKS PERMIT <br />� TY�a or Print ClePrly wit� ink <br />PRESS HARD - YOU ARE MAKING COPIES SS.I ,! Gi L <br />PERMIT N0. __ __' _—___— <br />PUBLIC WORKS <br />EVEf1E7 i, WASHINGTON �/O^r� E3LDG. DEPT. NO.__ _ <br />�OWNER ❑ AGENT DATE lr �/ <br />APPLICANT/FIRMREPRESENTED�<<<S /(vi�'6 �G _ __ ____ _ <br />ADDRESSpd-�C_ S��C✓��. ���_ .�'✓�_ _CI-Y�-"=�`c`_�_. _ fELEPHONE�SS' �L <br />HEREBY APPLIES FOR PERMISSION TO I�S%/%« �� I LII�f.� �1�(,i�P(-`%/����`-"��R" <br />ATTHEFOLLOWINGLOCATION � l�4___ ��"��� ���'1!`� �_.J/_���+_I�I'_s'�'�'" <br />Attach five (5) copies of preliminary plans tor proposed work. Draw to scale and show the following as appliceble: <br />• Property lines and street identity. <br />• Outline and dimensions ot existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />' Centerline of abutting riyht of way. <br />CONDITIONS: <br />PUBLIC <br />• Topopraphic changes requiring cuts and tills <br />other than normal foundation. <br />• On•site drainage systems when required. <br />' Erosion cantrol m hods when required. <br />Nort rro <br />` J(yZb[' -� --1 �- -_— — - - <br />PERMIT <br />I��r�, � L.� <br />. `-'(('�-�� ''7c'�� f C 1.1:+i'v�nP.�.� cirCa''_ !'> nci— .'�i� <br />Lu 1«'C" -�`, GIfCA�r�t��P Nl�l:..t �'+t' �.'.n�/":>IIPc� <br />J. <br />� <br />� <br />�:,r �-I f'ct r �.-rl . <br />l'J ,n �-� e I u'�"� <br />1�1�� �A�Y1cxr�� p�- h:Po.1�.G1��G 'tv ��v.r��lt- {(.1�,1.U. QCCi.rl1��.� <br />Cl�:e '� ('Q�lS1 1�tC� Y0:1 INNS� ��L jPr�:\1fPC� ��. 49ii t �C�Pr. <br />���e��,_. -+��, � k�-�I , �. iv � �, i � �- <br />CCNS� fv�GT�v.� ':>:�<'— IS -�c <br />�'U/l�t! J(�! JU r' �GX. IS "�i <br />IU�" clfc2clE_ (���or `v 1/�r.r.,l <br />1 � <br />��-7 � <br />- / - - �`_�y,�z- <br />A PROVED FOR CONSTRUCTION AT6 <br />I�_I,` 1`��!'` c�. .�t � - ��,'..i <br />PPPROVED AS CONSTHUC�ED � �ATE/ �� <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />' <br />T;,v. �:.�. --��.., +�,�:. , <br />r)(' C I f N.� % c` �.a. � C I�7 � l.sl . <br />W@ C<C� �" '_-1,':�\ �'.. �l �,�... I <br />�t10 ���-o.�..,1 <br />T��! unAersigned owner I�rrcOv ,^grers to holA antl save �nrmless <br />Ine City ol Ererau �rom any eno eu cieima lo� demnpas. coele, <br />e.nenses, o� wuee9 0� ecbon Ihet mny etlsa beteuee al inel�llellon <br />nnJ mainten3nce ol Ihe In.C���ement or ulhar nphl�ol�w�y oso <br />he�ato epp',ioJ lor and lurt�ei a9�eee Io remove s�me upon noUca <br />fmm �he City enA �o raplew Pubhc pmpanY demeped thereby. <br />OF CONDITIONS <br />v <br />,j' i ,�/�- ( � /�.�_ <br />'RE OF P ICANT - D TE <br />�� 'CALL FOR �NSPECTION <br />POST ON 259•8811 <br />JOBSITE yqHRS.BEFORECONSTRUCTION <br />0 <br />1 <br />J <br />