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e"e'�" APPLICATION FOR PUBL�C WORKS PERMIT <br />� Tvoc or l,nnt clenrly w In �r�h <br />PRESS HAfiU � VOU ARE MPHING COPI[5 �/3 Vi� <br />PERMIT NO. <br />PUBLIG W�� ��KS <br />[VERf.TT, v� \SHINGTON �, BLDG, DEPT. NO. ,f������`='/ :ti <br />: I UWNER ! 1 AGENT DATE �����.i - <br />C, <br />APPUCANT/PIRMREPRESENTFO t'_ ���C('��/C'.��,� <br />` � ��� ' - -- � - --- <br />ADDRES9 ''1��, i�� /j 'iy'�/ GLC . _ � CIT'! CG� Zc:.Z`� TELEPHONE��,-� — � :' � <br />HEREBY APPLIES FOR PERMIbSION TO . YJC����l�! )Z; �L� _�CL L(i..�` c'9 !��� ) ��.— __ <br />" � Z U.t! )l0 ��.(C ! �lJ� � � <br />�,� � . ut��tz`�o�-u � r ,.��-c. �i_�.��c-�.�r.-c'�L a'�-un��� - <br />nr rHe Fo��oiviNG �ocntioN ,�,i C�'_ � - .�..� �� �� � �C Y:��£�-fC; ; Ci_�C(=, <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />' Property lines and street identity. <br />' Outline and dimensions o( existmg and <br />proposed structures. <br />' [xisting and proposed utilities. <br />• Centerline of abutting ii�ld ol way <br />GONDfT�ONS: <br />Topographic changes requiring cuts and fills <br />other than normat toundation. <br />On•site drainage systems when required. <br />Erosion cqntrol methods when required. <br />Nortp arfbw �' <br />��� <br />„ ��, ,f, _i ) C ��,i�>� � <br />� <br />�� <br />:SqJnulwr AI�PI cnnl <br />LIC WORK� PERMIT <br />�y / � <br />/ �/ . �� � • l, 2 Z � ` <br />A IOVED FON CO TRU TIO ATE � � <br />� -A�0 AS CO�THUC ED �' ' L�A7E � � `J <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />In� m�prvqncJ ��wnr� I�nrPlry d1J�� = in hol(1 Ant1 RavP. hn�mless <br />v��� ��ny ol Evamll nom any ena au cleime lor demepes, msis. <br />, nnsPS. 0� C8119CH OI BCI1011 Ih91 T9y 0d6B bOCP��B OI IplllllThOn <br />a��d rnamtonanco ol I�e �mpmvemonl or o�her ng�4ol�wBY ��sP <br />hrmin epPbnd lal Bnd lunher egrees to remove Bema upon noI¢e <br />hoin me GiIY nnd la ie0lece o�,nn� o�ooenr �1Tmni�ed tnrn.bv <br />s <br />ACKNOV)cl�p MENT OF�NDITJO S <br />// % .s <br />� ' i �e../� .��_ <br />�f � <br />SIG A �APPUCANT DAII. <br />PGST ON LALL FOR INSPECTION <br />259-8811 <br />JOBSITE 24 HRS. BEFORECONSTRUCTIUN <br />