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r 1 <br /> � ----- � <br /> ---- <br /> ��" APPLICATION FOR PUBLIC WORKS PERMIT <br /> TNa a PhM da�rly wil�Ink <br /> PRE3S HARD-YOU ARE MAKIN6 COPIES <br /> PUBLIC WORKS , <br /> EVERETf,WASHINGTON PERMIT NO. _���/3/� <br /> r ❑ OWNER ❑ AGENT DATE 2=Z_�_ BI.DG. DEP7. NO.�� <br /> APPLICAN7/FIqM REPRESENTED �p_�(��t=p� <br /> ADDRESS 1_ D � I� �)y,�,� <br /> �n i� 1----�_CITY `� <br /> HEREBY APPLIES FOR PERMISSION TO A �"t � �s-TELEPHONE 4 B I g <br /> . <br /> � � +.n � � <br /> _ , � <br /> AT 7HE FOLLOWING LOCATION O I <br /> G ' <br /> Attach five(5)coples of preliminary plens for proposed work Draw to scale and show the followinp as appl(cable: <br /> ` Property Iines and street identiry, . <br /> "Outline and dimensions of existing and TOpO9raphic changes requiring cuta and f(Ils <br /> proposed strucfures. o�her than normal foundetfon. <br /> • Exiatlnp and proposed utilitfes. � On•site drainage syafems when required. <br /> •Centerline of abuttlnp right of way. ` Eroston control methods whe� required. <br /> North arrow <br /> P���I� sWMturoofAppliunl � <br /> WORKS PERMIT <br /> CQN.DITIONS: . <br /> � •----. <br /> . . . . i , _----- - . <br /> . . _ . _ ._ . _ . <br /> . . . . <br /> . . . . . . / <br /> . ; . . .r �� ' ���'��� ���rss . , �a:����,�� <br /> , : � � <br /> I : ; �� �''s'c /ri . _ ' I i> ' i��'c a r� . <br /> � `� � �[ie c� . �,./� ' <br /> �_: ._ � / /:�: � � �c - <br /> ,s'��� ;l�i-� <br /> . . �_f .s��,:rolc�•-�S : : ���i� : .�t.., �+ . : c/c!�-�5'7��� �-f%or� . <br /> : : ; � . j __:.: _. _ : : : ; . . ���lh'Cc�17-jy�f. . ; : ' <br /> _ � . . . . . "_'_ _ - •- - • . . . . <br /> ', � . � . . i : , . � . . : � . : . j ' � ; : . . ; . . . . : . . . , . _ . ._ __ : : : <br /> . ._ ' , • . . • • <br /> . � , _" t -�• ;— �L . � . , . . . . . . . . : , . <br /> . -.- . <br /> . . . . . : . ---- • . <br /> . . . . . i , , i . . . . . . . . . . . . . ___ . . . . _ _: _.. ._; _. . <br /> . , . . . , . .. . . .. � . . . <br /> . . . . � . . ; . . . . . . . i • • � : . . . . <br /> -_r --}��l.�� . . .T��_• ��_,- - � <br /> _ , . J . <br /> ' : ' : i . , i � � . � � : : � : _ � The undersipned owner hercby apreea to�dC uW uw hurtJsu <br /> .. .. . . .. • � ' . . . . . . . . . : . . . the Ciry of Everett trom any �na au cy�m� lor O�mp��, �� <br /> (j ' . . . .-�� � . � � � . . . . .. ___ __. _ _ eapsmea or cauxs ol ectlon tAu m�Y atl�e p�uuM d In�tNytbn <br /> and m�inten�nea ol the Improvem�nt or dMr ripht.dyr�y uu <br /> � � heroto�PPlled lor enA hrthar aprse�lo rempve y��pp��p� <br /> ' . . . . Irom the CIN �nd to rePNce Publb prpp�hy �m� tMnpY. � <br /> L � F 'ON f � ° A E� <br /> - +�� ACKNOWLEDQ MENi OF CONDITIONS <br /> � D AS CONS� CTEO �_"-F� <br /> DATE SIO UpEOF PLIC NT <br /> PERMIT IS VALID FOR 1 Y AR <br /> POST ON CALL FOR INSPECTION <br /> - _EXPIRATION '¢ JOBSITE �sa'��� "� <br /> 24 HRS. BEFORECONSTRl1CTION <br /> L '� <br />