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i � <br /> r- - - - � - - - �- - - -- 7 <br /> ' `"�'�" � APPLICATI..N FOn PUBLIC WOR1.� PERMIT <br /> il � ' . TYGe or print cla�Ny wll�Ink <br /> PRESS HARD•YOU ARE MAKINO COPIES <br /> � PUBLIC WORKS PERMIT NO. ___ _ <br /> � EVERETT,WASHINGTON S3 //Sy� �1 <br /> - � BLDG. DEPT. NO. <br /> � i �Q OWNER ❑ AGENT DATE _��a�3___ _ <br /> � APPLICANT/FIRM REPRESENTED -I��1t_�1i1�_�1"����t_f `,!. -Y� _ _ <br /> I ADDRESS .L��.�� �n E� ����p � _ __ - -- _ <br /> �L—<l-�i�___CITY �_ TELEPHONE �.S 3 33�1-� <br /> HEREBY APPLIES FOR PERMISSION TO ___�!,�i�___, � � I; �I,-,. / <br /> y �—��=���-��..-�— <br /> I --- ------ � <br /> ATTHEFOLLOWINGLOCATION _�_,�,��_��l��V�_��, W� <br /> I Attach five(5)copiea of preliminary olana for proposed work Draw to scale and show the following as epplicable: <br /> I <br /> • Property iines and street id�mtity. • Topographic changes requiring cuts and filla <br /> I ' OutHne and dimensions of aristlng and other than normal foundation. <br /> proposed structures. • On-site drafnage systems when required. <br /> • Exist(ng and proposed utilities. � Erosion control �nethods when required. <br /> • Centerline of abuttlng right of way. • NolfJh�rrow� . ��J� <br /> � ' <br /> l �'l - <br /> � fpna�ure ol AOP�canl <br /> PUBLIC WORKS PERMIT <br /> I CONOITIONS; <br /> � <br /> � : : ; : � : � � � : : ; <br /> � . � : � ; : . ; : �P� : � � ,..: <br /> � .� _ . <br /> : : : :_:_: ; � �� a b�� �µ"A►� : � : : <br /> � <br /> • ;� <br /> . � , . . . <br /> , . <br /> ,.. . <br /> . . . . , . . , . � <br /> . <br /> . . , . . . . . . . <br /> : � � �f z�z 3 : <br /> __ . ____. .__ _ . <br /> � . � , : � � ; . , r�� <br /> , . . . . . . , <br /> ____ _____ ______ <br /> . : : ; : , : : <br /> . . � <br /> __�____ t_�_ _ <br /> - . . . . . . . . . . � . . 7he un0eroignea owner nereby apreea to holQ and seve humlesa <br /> � � • • � . i � � , ti � tho City ol Eve�ett �rom any ena eu cu�me lor Mmapeti wsts, <br /> � � • � • � � � � � � � • � � e�panee�,or c�usae ol ectlon 1��1 mry vlse bsc�u�e ol Iml�ll�lbn <br /> ' ' - � • ' � - • � � � � � ■nd mainlen�nce ol I�e Improvement a olAar tlph4ol-w�y u�a <br /> ' - - � ' � ' � heielo�OO��eA lor�nA luriher�preee to removs ums upon notic� �� <br /> ' � ' � Irom the Clly �nC lo re0lace pu�lic proparty am.ow m.noy. � <br /> i APPROVED FOR CONSTRUCTION OATE AGKNOWLEDGEMENT OF CONDITIONS ', � <br /> � <br /> ( APPROVED qS'.:ONSTRUCTED DATE SIONATURE CF APPLICANT DATE <br /> i PERMIT IS VALID FOR 1 YEAR pOST ON CA�L FOR INSPECTNN <br /> � JOBSITE 259-8811 <br /> EXPIRA710N 24 HRS. BEFORECOWSTFiUCTION 1 <br /> . � <br />