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everett APPLICATION FOR PUBLIC �IVORKS PERMIT <br />� TYPe ar �rin� claerlv wilh ink <br />PFESS HARD • YOU ARE MAKING COPIES $a�� C�� _ <br />PUBLIC WORKd PERMiT NO. __ f <br />EVERETf, WASH�NGTON / BLDG. DEPT. NO._�'� / 6�7 � <br />�iOWNER ❑ AGENT DATE ���-: J �� - , <br />APPLICANT/FIAM-REJaRESENi£D //I? � i� � ^ /i� L �% _ __ __- --- <br />, /7 /J� � 7 v / (� <br />AODRESS,.Y��_�,(J��1-M-�.[L_�_//--___-___--__..CITYG-��="l'�%-1 __TELEPHONE,'„��}_�j <br />HERF.BY APPLIES FOR FERMISSION TO -(JL7�/J___�_C�ALLr�_L'�/�__[___ ___ <br />— _ _ . . --- --- - -- / �^� <br />_ - -- — <br />AT THE FOLIOWING LOCATION .../."/C�� _��G��__J���_ I)/� ��_-// •_____ <br />Attach five (5) copies o( preliminary plans tor proposed work. Draw to scale and show the (ollowing as applicable: <br />* Property lines an� street identity. <br />• Outline and dimensions of existing and <br />proposed structures. <br />' Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />CON�ITIONS: <br />,^ r n.j /�G f: 7 � ��G� <br />�•�,�, � . ; .- � � <br />- ._ ,. , . _, <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-site drainage systems when required. <br />' Erosion con�r .melh ds wh, r fequired. <br />' North arro jj� -, <br />�. � / <br />��� ��"�T ��-- <br />'« ! • — i wre ol Ava��cent <br />1NORKS PE <br />���; r,t.c;,vr� f%r �, t: ���:� i , <br />/ <br />r;_.'") <br />�/� ��`/� �—'� / ` <br />� �. Lf`".s C. �G- l <br />� PPRGVEDi?OR CONSTFUCTION ,- DATE <br />. �: � ..' . �1 �� � �I � ) <br />APPROVEDAS CO JCTED�� DA i E ��� <br />PERMIT IS VALID FbR 1 YEAR <br />EXPIRATIOW <br />1 • !�, :7 / ,(J 4- :) ���/� )'�� l�C <br />The untleisigned owner hereby agrees lo hold and 5eve hermleas <br />I�e Cdy ol Everall trom any eno au claims tor demapea, coate. <br />eMpenses, or ceuses ui aclion Iha� may erise becauee of inetellelion <br />and m:�inlenence ol the improvemont or o�her rlBh!'ol'wey usa <br />haratc app:ied lor and IurtOer egreee �o remove sert:e upon notice <br />Irom �he Cily antl lo repluce oublic proOeHy demaOeC Ihere�y. <br />— � SIGflATIfR FAPPLIGA " UAIt � <br />POST ON CAI. �OR INSPECTION <br />J0�3SITE 25���88� 1 <br />24 HRS. DEFORE CONSTRl4CTION <br />