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� `"°rc" APPLICATI�ON FOR PUBLIC WORKS �PERMIT . <br />Type or print clearly wllh Ink <br />� PRESS HARD • VOU ARE MAKING COPIES �1'�-Z�� (n <br />PERMIT NO. ' <br />' PUBLIC WORKS <br />! EVEFETT, WASHIN N ?� ,��� � BLDG. DEPT. NO..— <br />❑ OWNER GENT DATE 1 _�-�% � <br />I APPUCANT/FIRMREPRESENTED __�i'L��'NN1-1-�- I'`�G�IL1-IV��'� �%-i�-�---�-�-�'�' �I^�, <br />� -Sii��_�,� � ` <br />ADDRESS��Z`.�J =��• � ���Y CITYI_�t'�K�Z TELEPHONE��- `��3 <br />� SS �n�-�v <br />HEREBY APPLIES FOR PERMISSION TO Icl,i���L-.�YZLY E L�I/-�_.'>-- -- — <br />j— ------ ---- ---- <br />� 1, � <br />� <br />i ATTHE FOLLOWING LOCATION _��-'__—__(-�__- �-�'------- --- - <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show ths following as applicable: <br />• Property lines and street identity. • Topographic changes requiring cuts and fills <br />j • Outline and dimensions of existlng and other than normal foundation. <br />� proposed siructures. ' On-site drainage systems when requlred. <br />• Existing and proposed utilities. • Erosio� control methods when required. <br />• Centerline of abutting right oi way. • Norih arrow <br />� � r r � ' - ----- <br />� <br />. - - Signelure ol ApPlicenl <br />PUBLIC WORKS PERMIT <br />CONDITiONS: <br />, <br />: . . Pe r <br />; ` <br />l.. . . . • b <br />d <br />P1��5 ._�,6,��,,..5-' 3-�}-�L <br />� � 4-I i�4.r b � V N �f i �jF CT i�.. l+n N1 7 t- �� . . <br />-t?j C P w� o v� �Y o,; �� (��� � a � e_..= \' a•• <� 1 s h�i S ca ,.� - c.,t,. -i� <br />mI f\i"�«JJ�.�� -� � �nfu� Pli— :•v1.._t.�5io.-. � / .( <br />♦♦ l/Ni)CKIN �O Ti �� O�� (��.�r� -�'�'�'' I� �1Jt G1I`OW(cL?-'� <br />1. \ <br />-� ,�I /�. �., �, t k � Nn a S i > l f P vu •� ✓-�, b+i � v' �.,- '(1� %� /.��{ u � <br />�-{� �'1 fGIPS�` Cl��>ONGI.�•^ JO�•1/�-• — rP`� s,ri'ac..a/Ic <br />, <br />�c ��o,ns --lv b� �o,,.��� basic �o�� '� �� . <br />T�n undorsipned owner hereby apreee lo hold end swe �Brmlee! <br />Ihn Cily ol Everell vom eny ena au cbims lor tlam�OeR co�ls, <br />e�pon9e9.0� CBuees OI BCtbn thel mey �flee beC�use ol ln�tdl�llOn <br />. and mninlonence al I�e ImO�ovemenl o� olher rlphl-ol•w�y u�a <br />herelo eppbeA loi and furlher epmee lo remove s�me upon nollte <br />Irom Iho Ctly anA In replece publlc OropeflY d�m�ped I�eroby, <br />, <br />��--- >� � -� - l �_ <br />RUCTION -' DATE� <br />//!�'J� � ����(/ S �� <br />r1[:TFriI DATE <br />PERMIT IS VALID <br />\ �....... . _. ,... <br />KNOWLEDGEMENT OF CONDITIONS <br />/ � <br />'� ��` � ! �'' �`r= ---• � ' ��� �`j�. <br />.IGNATUAEOFAPPLICANT-' DATE <br />R 1 YEAR CALL FOR INSPECTION <br />POST ON 258•8811 <br />JOBSITE �nuoc occnorrnucro�irr�nto _, <br />1 <br />� <br />J <br />