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"�""` APPLICATION FOR PUBLIC WORKS PERMIT <br />e : <br />Typa or prlM clearly with Ink —� <br />PRESS HARD • VOU AqE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. �� f� <br />EVERETT, WASHIN� N <br />❑ OWNEFi p�GEN7 DATE �� � BLOG. DEPT. NO. <br />��=_..�� � � <br />APPLICANT/FIRM REPRCSENTED _ ��_V��NNi�1_{_ �4 �`i`y��� ¢ +1��L�__� _r�L�I�J, <br />ADDRESS —/ 7ZJ `:�� � (�, � �,v � � ��""-' � <br />CITYf��..[.Ki2 TEIEPHONE�•- '1 aJ3 <br />HEHEBY APPUES FOR PERMISSION TO �� rSI�,J� <br />�ll�� �th� ��l �c�-�/_���` -- ---- <br />AT THE FOLLOWING LOCATION _% � ,' /-� ( C� L _ _ _ <br />Attach Nve (5) copies of preliminery plans for proposed work. Draw to scale and show the following as appllcable: <br />' Property Hnes and street identify. <br />' OutHne and dimensions of existing and <br />proposed structures. <br />' Exist(ng and proposed utilities. <br />' Centerline of abuttlng right of way. <br />CONDITIONS: <br />i.. <br />i <br />i:.. Pe� <br />..., <br />� <br />`-. . . . . , <br />I <br />�IA.�S �P�uv�SJ <br />• Topographic changes requiring cuts and fills <br />other ihan normal foundation. <br />• On-site drafnage systems when required. <br />' Erosioq control methods when required. <br />• North arrow <br />� �� � r <br />- — �1- <br />� " � Slqnelwe ol App�icanl <br />3-�3•�Z. <br />I1p b\ 4I ��Unr F7 ¢ l/N YIP♦ �CC � It,.. Nn N] r .�•� . <br />� �PN^JJ�cY A.•d' (P �� IR (' '�t ` C'' . � <br />� � a r c� � S --i�� 5a .,- - t„i, -4— <br />- m r f C �� a��✓� -���> �n r< t i P 1 i- N h�� G+ .n 5 r �.. � <br />�� `� /'� � 1 <br />KVIUCKIH\ '� Tl ( O� (+l.r�j -{O'� �S �tt�Y Q;/` �� <br />�7 7 J / �w, 4 . <br />O�r �`i��P �vn �Ic 1�uwSi- �Jl �Nw.�✓.J� U�� slw 'i�ir/�/N G� <br />—�� rtfaiP,sf' Cr�GHLS/J., Joi•t�-. — /�p�.� si�Po�alk. <br />. Sc�c��oµs �� �e r�o��r� bacic (n�� ���%, <br />'; / 'G"�/� '� , <br />" �%� �i�'ii�iL— -_ � ) ' } ` <br />�'�..- DATE �- - <br />' �/�fJ - S �.� <br />DATE <br />PERMIT IS VALID <br />� �........ _..... <br />1 YEAR <br />Tne undereipnetl ownor no�c6y egrees Io hold �nd ews �ermle�e <br />the Cily ol Evernll nom any eno an c�eima lor dem�pdw co�t�, <br />e�pense4 or ceueee ol eclion IAaI may arlee beuu�e ol Inct�ll�lbn <br />entl meinlanence ol t�e Improvemenl or other rlphl�o4w�y ues <br />horelo epplio0 lor and lurt�er ep�eee lo remove eeme upon npfi�a <br />bom mc Gly xna lo �oplece puEllc property d�m�p� �he�eby. <br />KNOWj.EDGEMENT OF CONDITIONS <br />��f I � <br />.' \� i.�>.�t llr! :— __�. ____-'��'�. <br />. IGNATUTEOFAPPLICANT- �� DATE <br />POST ON CALL FOR INSPECTION <br />JOBSITE n� unc ocenne88nucTo��rr�nu <br />1 <br />� <br />J <br />