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i, "�rt` APpLICATION FOR PUBLIC WORKS PERMIT � 3f S <br /> �� � TYPe or orint cleatlr wilh ink —(-C' /l�( <br /> �, � PRESS HARD-YOU ARE MAKING COPIES pERM1T NO. �(��— <br /> I PUBLIC WORKS - � <br /> I EVERETf,WASHINGTON �� BLDG.DEPT.NO. <br /> I O OWNER ❑ AGENT DATE �� ( � ' <br /> II APPUCANT/FIRMREPRESENTED �f1LL�i_-���SC f��f�=.��11f�{ <br /> ADDRESS �D�F 4ll'u +� �—�E--�E� - CITY �-rv�� TELEPHONE 33�J-G(,h'tr <br /> I -/� <br /> ', HEREBY APPLIES FOR PERMISSION TO ` �U rG�C �� ��, ^ �� <br /> l a 3 � <br /> �, AT THE FOLLOWING LOCATION �' — <br /> ' Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the following as appliceble: <br /> I <br /> � • Property lines and street identity. 'Topographic changes requiring cuts and fills <br /> " Outline and dimensions ot existing and other than normal foundation. <br /> j proposed structures. • On-site drainage systems when required. <br /> ' Existing and proposed utilities. ' Erosion control methods when required. <br /> I • Centerline of abutting righi of way. ` North arrow <br /> �C � ( . 5�10 Ad� <br /> � � slanature ,lvvliwid <br /> � PUBLIC WQRKS P�RMIT � '1 <br /> I �,,. n,�..,J v�o.c.tc_. �.,.. s:�.�Ce w�-.�t a� c�.�.�� w�-�X <br /> i CONDITIONS: I � � <br /> , � `�,��,� �-�� <br /> , . . <br /> I � � :_: :_ : : . . . `�. . l� c� ir���,,�,,.:,�.�.�.�„ /a ' ,,� . <br /> ; , ; �. . . �' �� : <br /> � � _: : : U.ru��. o _ _ . <br /> �._ � . . � <br /> ; # : : � �p,._�w�.� �� o...�t w vu.w�i,r.�.-.,___• : <br /> � _, � � � � � . . ; <br /> i � �_ : : . : . : � . �,.�._: . ,;,,-tc�:�, • . . . . . . <br /> I I <br /> t� <br /> , ?_: : : : ':(� �"���� b�.�,.«R �s �C0.�� �L . <br /> . . . <br /> . . , , �` s�rw` "' -�'` o.n.Q c� w. �,.�e,� � <br /> I –�–��'^-� - ' ' '-� � - � � � � 1'he un0ersigned owner hereby a8rees ta hold anE save�armless <br /> �r ihe City of Everett Irom any antl ell claims lor Enmaye& coata, <br /> I ' ; � � t � . erpenses,or causas ol Actlon t�91 may etl6e beceule of illntellatlon <br /> i � : . � , ,_ , � . . . . . . . . end melntenence ol Ihe imOwvament or other dghtol-wey une <br /> � . � hereto aOPlied lor end further e0reee lo remove neme upon notice <br /> �I � _ � � � . . trom Ihe City en0 to re0laca public pmqfrty dame9ed thereby. <br /> _ Id�� <br /> IR F O R C O N U C T I O N ATE ACKNOWLEDGEMENT OF CONDITIONS <br /> � � ��t ' <br /> ; � - <br /> q D �STR TED ATE SIGNAT EO APPLI ANT C''�TE <br /> PERMIT IS VALID FOR 1 YEAR � CALL FOR INSP�CTION <br /> POST ON 259•8811 <br /> JOBSITE 24HRS. BEFORECONSTRUCTI�DN <br /> EXPIRATION -__ - - ! <br /> , _ _ <br />