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r <br />r <br />r <br />� <br />i� <br />L <br />°�'°" qppLICATION FOR PU9LIC VVORKS PERMIT <br />0 TY�r or onnt cbulY wtlh ��k C <br />PRESS HARU � 1'OU ARF MAKING COPIES pERM1T NO. (,3�`� �" <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. NO. O-� .�L'� LJ <br />� �.= 5 S <br />rjCOWNER ❑ AGENT DAIE � - -� <br />.',`,rcrs f/nm:�5 _:�,.��� . _._-- - - <br />APPLICANT/FIRM HEPRESEN7E:D . - — <br />, <br />�',.�':'. _`'__. ''-:!('r '-'�J''/1/C /'C�f'/ ___CITY'_��_�'�----TELEPHONE_.__'��� _ <br />ADDRESS._ -- - - <br />���Si :! '. /� �. � {„ ��� ,• � �•' . "L''��• _ -- <br />HEREBY APPLIES FOR PERMISSION TO �-=-- -�--�- ---' -- -- <br />-- <br />--�-------- <br />_ — — �1 /.S �S^ <b � <br />— /. /A,� C <br />� / ) { ; � � C %.�.�- i!'iC��-� ^. / _ - _ _"--fi - J.W <br />ATTHEFOLLOWINGLOCATION -L_�._���- -- ---- --�- ---- � <br />Attach five (E) copies of preliminary p�ans for proposed work. Draw to scale and stiow the foilowing as a�+plicable: <br />• Property lines and streel identity. <br />• Outline and dimensions ol existing and <br />proposed structures. <br />• Existing and proposed utililies. <br />• Cenlerline of abutting right ot way. <br />CONDII'IONS: <br />• Topographic chan9es requiring culs and (ills <br />other ftian ncrmal found��lon. <br />• On�site drainage systems when requfred. <br />' Erosion control methods when requfred. <br />• Narth arrow �: <br />� <br />_.� : �' --- _ <br />�;., <br />___---.--- <br />_^�' � _._•.-.•-SOnelu'e ol APChqnt <br />��'�yrpr.� •bc�I�•� CUSP�.af...: ar�.. �5 <br />L �i-•v :�� c�cuir.X <br />ncI <br />�, ! 4� P�!,i,� ,z/,,.. ,t -!� b� <br />2. ��br �, �, .l, � r--1-f�.. � r. �., <br />� An�� <br />3, <br />� <br />S <br />PERMIT IS <br />��S ff� .,s�6�e .��, �P(�n�r nll r�nw.��e i.. I�..bl,� P-%w <br />�icc...�' � l' <br />fl1NSt.I% ,�iV r� '��� ON,lL7 I <br />CiJ✓�'�"VI IT�t�'`• �u� �II��.�P\< c.n �i�r �oi� <br />J / / <br />7'�NAI Ci/R(IC. <br />Ac�J��t" Eur'�rr Sr'r,;�rt Un�v� �� % i <br />EXPIRATION <br />�c� ��� �� <br />DATE � <br />� �,_ <br />�'1- pl�'� <br />FOR 1 YEAR <br />7he untic�vgne� ow^"� ��PreUti egrees ta bold enG aeva hermlxes <br />ine C�ly M Everatl nom �ny ana eu Caime lor Eem�pe�, coeU. <br />e�penee6. o� teulBe OI BCIIO� �hl� llleyli��B �eC�utG OI1plIlIllIlOn <br />aW mainlenen<B at I�B ImOrovemenl O. ot�er riphbol�wey uee <br />he�elo epolied loi x�cllurtner aQreea lo �enove name upon nollce <br />Irom the Cny enA lo �eVlece o�ouc �rooenv a�maQee mareoy. <br />POST ON <br />JOHSITE <br />:MENT F CONDITIONS <br />l�_ 1-: z �, - <br />PP I�ANT DATE <br />CALI. FOR INsrt� i ��+ry <br />259-6611 <br />24 HRS. BEFORE CONSTRUCTION <br />1 <br />� <br />�l <br />1 <br />J <br />J <br />