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��aw <br /> „-- --- --- - �- ---- '— .�, <br /> eYNp" APPLICATION FOR PUBLIC WORKS PERMIT <br /> � � TYPe or Print clearly wi�h ink Q �. <br /> i PRESS HAR� YOU ARE MAKING COPIES 0 a/(� Z <br /> PUBLIC WORKS PERMIT NO. <br /> iEVERETT,WASHINGTON BLDG. DEPT. NO._ a / Do77�� I <br /> ❑ OWNER �-AGENT DATE _��SZ— _ <br /> APPLICANT/FlFIM REPRESENTED �p_�/3 SF C o il/S T <br /> i��f/'/�!✓�L/� �e�f�ye.ne /�'O <br /> I ADDRESS _ " • � /��f� CITYS/i9/VLv�a/� 7ELEPHONE �^9— 5�S� <br /> � HEREBY APPLIES FOR PERMISSION TO �u/� R /�-1 � X 2U � Ct,t� �O/l7" /'�TTf�c I-r c°� <br /> TfLC_YiSriniG /�« i��,.n�� GrX/57/�� d-L_�-F� d r"��S � <br /> , � � I <br /> IAT THE FOLLOWING LOCATION � � � n <br /> Attach five(5)copies of preliminary plans tor proposed work Draw to scate and show the following as applicable: <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 control methods when required. <br /> ' Cent�rline of abutting right of way. • North arrow <br /> �� � <br /> I � <br /> I � ignaNre o�nt <br /> � PURLIC WORKS PERMIT <br /> ICONDITIONS: <br /> i , . . . <br /> � , � . . � . . . . : . , <br /> I ! . . . , � . . ; <br /> i � I • , � , . . . . .. <br /> ; ' k_:_.:-.- �-_1. _ . - - ._ : _ . . . : :.: . : . . . : . : : _ . . _ : . . � . : <br /> ; f . . � : <br /> ' '� ��_� ._ _ . ._ . . . : : : . : : : . : � . � <br /> ; . � , <br /> � � ' ._. . . . : . : : � . : ; 1 : <br /> ` ~ 1 � � . . <br /> � , <br /> „ , , � <br /> , ___ <br /> ._ . ,-1 ._ ' ' ' . .. . . . . . . . . . . . . _ . . _ ... "_'. _ '. . '_ 'r�-. <br /> I : : ' '. � ` . ' ' : : , : : ' ; <br /> i , . , . i : <br /> _� <br /> II �� r..L._._�.� ._. iL7�i t, +J i��� . . 1 .�.. -- • . . . . . , . . . . . . . . . , . . <br /> 1 . . . . ' . . . . . . . .. . <br /> I � . . : . � � _ . . . , ._. <br /> { .•t � <br /> _._�...� �.1 <br /> � .. } _ . . . __. �. �.. . . � Tne unAersigned owner hereby agrees lo hold and save harminss � <br /> iI . :���L.l..; .; � . . . Ihe Cily ot Everett Irom any ana eu clalms for tlama9as, cosis. <br /> . � � � � � � � � � � - � eapenses,or causes ol nctlon thal may adsa�ecauae ol inatelletion <br /> � � � � • � � � � � � � - - � � - and meintenence ol Ihe improvoment or other nphl-of-wey uae <br /> I ' - ' ' � � ' ' hereto applied lor and luriher aBrees lo remova sama upon notice <br /> ' Irom the City antl tn replace pu�lic propeny demepetl Ihereby. <br /> { � -` � <br /> /.� •„�r—�—/----,3— S—� Z <br /> ' f <br /> OVED FOR CONSTRUCTION DAT ACKNOWLEDGEMENT-qF CONDITIONS � <br /> I _....'_ <br /> ' � — y�BZ_ �� , � <br /> �� <br /> � 1 �- �c,��C c-- <br /> I APPROVED C TRU DATE 'SIGNATUREOFAPPLICANT DATE <br /> � PERMIT IS VALID OR 1 YEAR FOST ON CALL FOR INSPECTION <br /> 259-8811 <br /> I� EXPIRATION _ JOBSITE 24HRS. BEFORECONSTRUCTION � <br /> \ <br />