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`� APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or prinl clesrly wllh Ink <br />PRESS HARD • YOU ARE MAKINO COPIES -, <br />PUBLIC WORKS PERMIT NO. ��-- / _ <br />EVERETf, WASHI TON � <br />�// BLDG. DEPT. NO. <br />❑ OWNER AGENT DATE _�� 8� yy ���� ����� ���� �/��o <br />APPLICANT/FIRM REPfiESENTED /l�i.//_� ��/ _�/-�fjGi-5 �I� <br />ADDRESS �J� �� � �_��Q � �J' ��'��,� <br />��� ✓-� �CITY/_�1=�TEL HONE,�i�,�'�i <br />HEREBY APPLIES FOR PERMISSION TO s`_ " !�G_PiXC�SS �CGd.�(��r�_j/�!ry <br />�h__���G S ' S'f SH% � /�Y�S _�s de ��S/�l1c.�e�,-5�..�, <br />AT THE FOLLOWING IOCATION K/S£�LA� �Cfi�q �Gi��i. /.>.J i�: n/ .�.s� <br />Attach five (5) copfes of preliminery plans for proposed work Draw to scale and show the following as applicable: <br />• Prop Ilnes and s�ir �ldentity. � To�r�g�p hic changes rgquifing cuts and fills <br />• Outline an rt i�"ons of existing and other th�-��undation. <br />propose ,a uct • On-site inage///���ystem required. <br />� Existi nd proposed uti s. ��r ' co rpl/netbedswl�en req . <br />C erlfne of abutting right o ay. arrow ��� J <br />CONDITIONS: <br />; � <br />PUBLIC <br />IT <br />/��i1 � C r �lt /) � c. �/ �� /�d f �, <br />3���% y�3 <br />�'' != roSio�q ��lZ�rv� <br />/ . <br />� t'- ,! tt Ti.f iU tfi'�z <br />.�r,fiC��c>� fz+ ,' <br />/ <br />i...;.. :.. <br />�. <br />c'f�r'Pd <br />S-�i � l( �� i r.s �t,i% d ;4� <br />r <br />nf� ;/�� /� �,% � C��,.�s <br />� /l /� <br />� <br />l.�_— -�'��/C�.G — <br />A D F � UCTION DATE �c/S !� <br />� o <br />� / <br />!�_ ��� � �- - <br />APPFlOVE� CONISTR Cj�D / D�� SI( <br />PERMIT IS VALID FOR�R <br />�c� ��S POSTON <br />�.....�._.,,.. < ��%a:� .109SITE <br />The undersipne0 owner nereby eprees to nold �nd ��ve �ermleef <br />Ihe C11y ol Eve�ell trom anY ena an c1e�n�e lor dem�pe4 coets, <br />e.penbe unee ol Bctian Ihsl mey �rise beC�ues ol In�ldl��lon <br />en0 in�nanc ol Ihe improvement or other tlphlobw�y uee <br />hew{6 au ��od lor a d lurt�er epree� lo remove ume upon nolir.e <br />�ronl Iho �ly and � r9plBte publiC proporty tl�m�pld IhlfBby. <br />,I CALL FdR INSPECTION <br />,� 259•BBII <br />��Y�nn nr_rnnrni+u.�rn��nT�r��� <br />1 <br />