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- ---- �_, <br /> � <br /> ,. <br /> �°°°`°" pPpLICATION FOR PUBLIC WORKS PERMIT <br /> TY7a or Prinl claar(V wlth ink <br /> PRESS HARD-YOU ARE MAKING COPIES pERMIT NO. �'3 6 3 <br /> PUBLIC WORKS <br /> EVEfiETT,WASHINGTON BLDG. DEPT. NO. � <br /> O OWNER O AGENT DATE 3�3/- 83 <br /> APPLICANT/FIRM REPRC-SENTED ��✓�a f-�Gc/Cf <br /> ADDRESS _ /���� /.�x �(,o CITY �,Jl���� TELEPHONE .�5�-Q$^Q l <br /> HEREBY APPLIES FOR PERMISSION TO —C��57�R�c��,La !-"A,tnL y P.'P <br /> ATTHEFOLI.OWINGLOCATION ��3� i�•� �+�✓+N� �G� 3 L�LK 2 oFA�Li�/J�'� <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br /> ` PrUs�erty linbs and street identity. • Topographic changes requiring cuts and fills <br /> " Outlfne and dimensions of existing and other than normal foundation. <br /> proposed structures. ' On•site drainage systems when required. <br /> " Existing and proposed utilitfes. • Erosfon control methods when requfred. <br /> " Centerline of abutNng right of way. • Nort-'tj�W ------ <br /> �pnature oie�nl <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> I . . . . . <br /> i . . . . � �� �OfNS� c+y.�; c�e�Orit c�ecut.Y � �... �ot� <br /> i , n <br /> , . . . . 15 � �o� �na�.\rY �v�o...._ 'E-�.c �%vreo� <br /> i . ._.. _� . . . . . . � <br /> � . . . . . . <br /> i <br /> i � . ; . . . . . . . , , . . <br /> . . . . . . . , . . . . . .. . . . . . . . . � . . . . . . . . . . . . . . . . . . . . . . . . : . . <br /> j . . . . . . . I .-. . . . � .-� - - . . . . --� -- . . . . . , . . . : . : . . . i . I <br /> f . . � , � ; � ; . <br /> t . . . . _ . � ; _._ � _ .. �. _ <br /> � <br /> . : r � . . . , . . , � . <br /> . . . . , . j . . . � . . : . : i <br /> . . . . ; . . . . I� <br /> � , , , �, � . � • � ; . � . • Tha undaraignetl owner hareby aprees to �ola and aave harmlea� <br /> , . . . . , . , . , . �he Gity ol Ev�rett Imm any ena en clalms lor damnpe0. coeta, <br /> � � . � � � � � � eepenaea,or cauaes ol acllon Ihel may erlee beceuse of Inelellatlon <br /> � � � � � � � � � � � � � acd mainlenence ol Ihe improvement or other tlS��•a�•'�'ay uee <br /> �. ' ' ' ' ' � � ' � � horelo eppllatl lor anA lurlher apreee�o r9move ea�ie uD����ollCa <br /> Irom ihe Clry nntl to repleco Oubllc propa�y demepad Ihereby. <br /> � O^f�s3R� ST IC 0 TE ACKNO �DGEMENT/OF/CONDITIONS � <br /> �'" ' �v o1/r•'6j � A�� 'i�- //- �3 <br /> �J <br /> OVED A ONS DATE ''51GNATURE OF APPLICANT DATE <br /> PENM17 IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTIOH <br /> 259-8811 <br /> � EXI�IRATION JOBSITE 24HRS. BEIFORECONSTRUCTION _ <br />