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"'"�" APPLICATION FOR PUBLIC WORKS PERMIT <br />� troe or orim ae■ny wnn mk + <br />PRESS HARD - YOU ARE MAKING COPIES Y,-��fi �. <br />� PERMIT NO. — _ <br />' PUBLIC WORKS <br />I EVEHETT, WASHIN N �� _� BLDG. DEPT. NO. <br />❑ OWNER GENT DATE ;�' � J� �� - <br />i � '� <br />APPLICANT/FIHM REPRESENTED _ C<•'1.2�-?L I�i�": 1-1- - L�G- (Li�1J`l -� '�--f 1�1--k�—�"'' '`'` �I^�. <br />5 ��IT+�_:'.-� <br />i ADDRESS �I �ZJ ��� • =- � � �Y _ CITYI ��K�{ TELEPHONE �=� <br />� tS I.-/��-+ V <br />I HEREBV APPLIES FOR PERMISSION TO 1�"3��_ .__U_i�1.5C.�1�-?/=f `� —.__-__ <br />_ _ _- -L-- � <br />AT THE FOLLOWING LOCATION __7—�--L_�_ ��' !"— _ <br />Attach Nve (5) copies of preliminary plans (or proposed work Draw to scale and show the following es applicable: <br />• Property lines and street identity. ' Topographic changes requiring cuts and fills <br />• Outline and dimensions ol existing and other ihan normal toundatfon. <br />proposed structures. ' On-site drainage systems when requlrad. <br />• Existing and proposed utilities. • Erosion control methods when required. <br />• Centerline of abutting right o( way. • North arrow <br />.y�,. <br />�, <br />�r . <br />- Sipneture oIApPLc0n1 <br />PUBLIC WORKS PERMIT <br />CONOITIONS: <br />' <br />� <br />Pe. >1�,.,5 .:�6>���.�.= 3_zs.�z_ <br />C <br />le 'b\4I ��Unrb � UN�Pi `�f'C�iv.. Nnl�1T' <br />-� (FvNov�J� ��-<i� �����a^e_c-�' a.^ci �s <h� <br />b� . <br />5 a �- - C�.�,. i-� <br />�' _�� w r u i r' ��i— � T� c;t .n s � o.� . <br />.U/ l C��^a�.✓ � 1 <br />�� t/VI llC 1� IN \" Ci �� I' O�' (^u r� -{�0 I� �� 1t J i 6ZI�01.N /(:-� • <br />� , 1 <br />v <br />� l w -('i. % �vr r7 r <br />� ��pw s���Fwal�c <br />7'�/j� c,� , <br />� _ : : a. ..� ,�� �. .� �. � k �.. .. � E <br />�, .+�arPsf <br />�jl�C��ONS � ��� <br />I;.. . <br />(_��........ . <br />l . . . . <br />� . . . . . <br />� . <br />PERMIT IS VALID <br />\�.._.-•-.,... <br />�e rp��,��.J iJ�i <br />CT/9iJNSlJ .+ /Q/�f ?'"• <br />✓ <br />�o.,�-U bask �Oii <br />Tha unAeisipned owner hereAy epreee lo �o�A end uve nermless <br />Iho Ci�y o� Eve�elt vom pny �na eu culmt 'a� dem�4e4 co�iti <br />e.peasos, o� ceuees ol ecllon I�al mny etlse becau�s ol In�ldl�lbn <br />anA meinlenenco ol Ihe im0��emanl or ol�er tlpAl�o4w�y u�e <br />horeto epplinA lor end lurther apraea lo remove ume upon nolica <br />Irom Ihc Cny and In repiaca puhllc omperty UemepeA I�eroUy. <br />-��'-��.� - l� � <br />- ^�- pq7E � KNOWLE-DGEMENTOFCONDITIONS <br />{ <br />� Jy!t/�� t� �Z— . , ,! i . `; �,, � ,�. ' � ' � �y?. -- <br />�7'p ' IGNAiUHF OF APPLICANT � � �TE <br />1 YEAR CALL FOR INSPECTION <br />POST ON 259-8811 <br />1�BSITE �� uoc ocrnocrn��cToi��`v�nr� <br />1 <br />