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PVef" APF�LICATION FOR PUBLIC WURKS PERMIT <br />� TYPe Or Onnl Ueerly wlt� inY <br />PRESS HARD • YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NU. x_� _J�_�= <br />�E ERETf, WASHINGTON -7 BLDG. DEPT. NO. $�����9 <br />OWNER ❑ AGENT DATE �D "`'���� <br />�/'. <br />APPLICANT/FIRM REPRESENTEQ t (« <S ���<< 5 ,/ it,Y _ _.___ _ <br />ADDRESS���P_—S�_4!__�Vc��T� /��fl[C_ �G�/��ITY _C__✓_�=�j��(--TELEPHONE�SS-`IYS7- <br />/ T <br />HEREBYAPPLIESFORPEHMISSIONTO�N���<< �} ��d� IPN����� d�'h'([._tZt�-�. <br />��; ���i _ v ,��N<<�� y/ -7 +� - ----- <br />ATTHEFOLLOWINGLOCATION _ _ __ LS71/%ZS� �(i /S r1, S,�Wo <br />Attach (ive (5) copies of preliminary plans for proposed work. Draw to scale and show t`�e following as applicable: <br />• Property lines and street identity. <br />" Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Centerhne o( abutting right of way. <br />CONDITIONS: <br />• fopographic changes requiring cuts and fills <br />other than normal (oundalion. <br />' On-site drainage s stems when required. <br />rErosiQn control m�hod��when required. <br />RKcS PERMIT <br />! ol �pPlicanl <br />,. � . <br />� 1 �, / / <br />/. l7�ef •, - L�l �! e(,sP rn P..T dr�•�s_ �J „� � ,7� 6P !�/eC.'..t <br />1. �ou f- � �� �//�a, n uJ C ,ee � s t b r c'z�n T�n //i.y c�., 1��: e- <br />��' r . <br />.3. /dii� C/i�vw+a3 r a�r L/rtn. �Eas P Q� �w Ei�i� ii.'U t-�. O/e'!•Vrri r.� <br />��ur-� C�.sSO�2ef•�-� n.vS/- �ir il�.���'ir1� �'y Ur..���G <br />/• YG'L'nJ �%'Q'�'F(�1��nJ�/J �e.��i it'��: .fyG..n Wli'f S��C <br />�J �� �7 C C-Ilrinrcf' L�/� lICJ� I% <br />J. iYl�us/" t���i�r/ }a. ��,< <v L'�'�rr �r.y �fD Y-�-•�:��'t %ia��P. <br />��—�_�/r�'i Z-- <br />. V D FOR CONSiRUCTIQN DATE <br />����l��u� �,,��.. z- 9-�3 <br />APPROVEC AS CONST UCTED � _ DATE <br />PERMIT IS <br />EXPIRATION <br />D FOR 1 YEAR <br />lli�. �. u. .i.�r.r,l uxrn.i �n�,rLv aq,ne[ lu hnlA anA snvP h� �m1e95 <br />R�o �.ily ol EvPn•II IIUm flny I1n0 011 CIfl�RiS IOf dBf1�Hg96. CO6I5. <br />e+pens�es, or wuses ol aclion Ihat mey anae baceuee ol melellebon <br />end mamlxnence ol I�e improvemenl or olher riphl�ol�wey use <br />nerelo aon��nd lor and lurine� ngrees lo remova aeme uvon nolicc <br />Irom the Cily end 10 mplace public property demsQed Uereby <br />IT 9F CONDITIONS <br />l� i/ �-_��-� <br />ICANT DATE <br />POST bN I �AIL FOR INSPECTION <br />259-8811 <br />JOBSITE 24 HRS. BEFORECONSTRUCTION <br />1 <br />� <br />