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. <br /> ""'�" APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Grin�clearly with ink Q , <br /> PRESS HARD -YOU AFE MAKING COPIES pERMIT NO. o� 7 S <br /> PUBLIC WORKS , <br /> EVERETT,WASHINGTON �� _ ' ` _ g L BLDG. DEPT. NO_ — <br /> Q�OWNER � ❑ AGENT DATE – . __ _---- -- <br /> A ��/��! �y/--- ' <br /> � �-- / <br /> APPLVCANT/FIRM REPRESENTED � -��--� -- � -- � -i ----J`--��-�—��--�---"��-- <br /> AD'LYRESS --� `-' �'S–� L � —CITY �v r TELEPHONE Nc�lt , <br /> HEREBY APPLIES FOR PERMISSION TO �--��='�� �_ <� � ^��f'—`^� � ^ -"Cro �– <br /> _ qrd �'___ JfapFr'��} I�^ �. .,. <br /> —� -- � � ---�—�--� <br /> T 1 "—�--- '. <br /> ATTHE FOLLOWING LOCATION _ �'''�.U - - �� � F � -- ------ � -- '� <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show tha following as applicatrie: <br /> ' Property lines and street identity. * Topographic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. * On-site drainage systems when required. <br /> � Existing and proposed utilities. ' Erosion conVol methods when required. <br /> - Certertine of abutting right of way. * Nort arrow <br /> _ - �;`. - �� <br /> -- ignature� pplicant . <br /> PUBLIC WORKS PER IT <br /> CONDITIONS; <br /> ` . , <br /> . . � . ' e V.i ., n i ... .,, . , e..�{.>w(�'�U�< \ne�.�i,t�-' ...F� Va� � Z tnclnP '�� . .. -. <br /> ,__..�_._ . . «�:,.��v� ��c. �:.� �cc F ���ci r �„�.. t L. h r u� ��� . . - ' .. . . . . . ��� <br /> , � . .. . . . . . r . . . . _ ,. <br /> � _ , �� ` ' .-�.. .n �... , _ . . <br /> � ,. . . . . � . �'�.�. tG'. \c � . kr� 1�.i7N `>"4�f�^ ��Tf,1,' a� . vv� i � . . . <br /> _ .. . . . , ( t .� f . . . . . . -. _-... <br /> L_._.__ . . . . (,1., Ip U c iL 6s. t'� b 1�l''W 4' ��G_. . . . . �. <br /> . . a �� S -�ee. � `+o��.� �.., - . . <br /> ' . <br /> t �: :. �.. . . . . . . . ���. <br /> .---__ F�,��� -rA��,ri ��,�.��1 <br /> . . . <br /> � � � . <br /> �- -_ . ;���,,�-,�� z� �3 _ <br /> k- � <br /> E _ � � <br /> � <br /> , <br /> �— - �� � � � ��� ' - � � ' � � �� The untlersiqr�ad owner hereby a9rees to holtl and save harmless '� <br /> � � � � � i the City ot Everett trom any ana an ciaims lor dameBea, costs, <br /> � - ' � ' ' eepenses,oi causes of action Ihat may arise beceuse ol inatalletbn � <br /> ; � ' , j antl maintenance ot ihe imOrovement or other rig��of-way uae ', <br /> hereto aOP�ied tor and turther agrees to remOve seme uppn notice <br /> r' / irom t�e City antl to reD�ace Dublic property AameqeC thBreDy. � <br /> <<' i / <br /> _- . � _- 3-/f• 8 L i '', <br /> < <br /> � <br /> ROVEDF i�CONSTRUCTIOW� DATE ACKNOWL�DGEMENTOFCONDIT NS � <br /> . ..___ .._ _�� � <br /> ���-6„� _: , <br /> _ - <br /> PRQVED AS CONSTRUCTED DATE � SIGNAT RE OF A ICAN C AT ��. <br /> Ig VAitD FOR 1 YEAR C LL FOR INSPECTION ' j <br /> POST ON 259-8811 1 <br /> .3- /t"�- �"j JOBSITE 24 HRS. BEFORE CONSTRUCTION ' I <br /> EXPIRATION -- ' <br /> I <br /> � <br /> �. J <br />