|
"�
<br /> i
<br /> .
<br /> � APPLICATION FOR PUBLIC WORKS PERMIT
<br /> Type or o���<<�eaAy with ink
<br /> PRESS HARD-YOU ARE MAKING COPIES �
<br /> PERMIT NO. ''Z �
<br /> PUBLIC WORKS
<br /> EVERETf,WASHINGTON BLOG. DEPT. NO. �
<br /> ❑ OWNER ❑ AGENT DATE _�_a� _
<br /> APPLICANT/FIRM REPRESENTED —_1_1�`'��1��-�--
<br /> ADDRESS ��� JJOOIdiv��� �� CITY ���^��� TELEPHONE �Jg"�Oy
<br /> HEREBY APPLIES FOR PERMISSION TO ��'�`* + �'� ��«�Qy �`��� �—
<br /> 'a-/la1 � c�� � � - 1..
<br /> ATTHE FOLLOWING LOCATION �a �%". r�\\IwJ I�t�
<br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the(ollowing as applicable:
<br /> ' Property lines and street identity. ' Topographic changes requiring cuts and fills
<br /> • Outline and dimensions of existing and . pn-shte dra nage systems wh n required.
<br /> proposed structures.
<br /> • Existing and proposed utilities. ` Erosioi control method required.
<br /> * Centerline of abutting right of way. • North rrow
<br /> — � Sipn re of AODlicam
<br /> coNoiTioNs: PUBLIC WORKS PERMIT
<br /> � �
<br /> , � ,
<br /> , - ,
<br /> � ' � - � :_ . �
<br /> , �� - '�ds�- 5 �� ���.��1 �S� �� 5 a i= � w-- � , . i
<br /> } �� ;
<br /> , � , ` ' 1 ,
<br /> �-�... :. . lY ��� ��.w� � ��Nr� �J �.� ,V-� -�-� �' �� �: - �
<br /> . ` I �
<br /> :_y�� � � �
<br /> _� �-C ���„ u,�.. ��: i � S ��a�� . . . : a�
<br /> + . . 1l ,
<br /> , , , �
<br /> :-; ;t-- � � , � E_� � .- ,
<br /> ��- =r-a-'- � u , .� �.._� , �-, � : . �
<br /> ��.. .. � . �._A._. I � �� '� . ,• � I ' � r `� , � ,
<br /> .. __ t� j ;_.. i t f � � 1 ] j t t I L �-i ,_.,_.I �. � � j � � ! -i ;� t '.._� � � � 1-,-i-'
<br /> 1
<br /> ._
<br /> $ T r r- 1 , - � � � . � -+--�-{-
<br /> . `
<br /> �.�-� L�r-�_,_�_�__��_.} � -1- .4 � � 1�'- , � � � E �_� , i": , i �.�
<br /> , 4 ��.
<br /> . � � `1
<br /> �
<br /> � � ,
<br /> �_I �# � � :� , -i-� ' ` �-; f 4 � --_ [ � 1 { ;_ ' . _
<br /> � �
<br /> ...y ��� 1 �
<br /> i �+ � { � �j� 1�� I � . _ ! �. �+-7-:--1--�__..
<br /> . t
<br /> � � 1 . � , ..1..1_� ' ,-t t � 1 � ..
<br /> ,� —� ' - � � - The untlersigne0 owner hereby ng�ees to holC and eeve Mrmkae
<br /> .._! l I i_i.. � ""_ � .i_ . � --L_L..— i , .. •
<br /> , , � ; ' .._. , ,. � . . the Ci�y of Everetl 1rom any ana au C�aime tor d�meC.e�, w��t,
<br /> � � � � � � � � - � � e.penses,or ceusee ol actlon thet mey arUe bec�u�a ol In�tNl�tbn
<br /> � � ena melntenence of Ihe impravement or other tlp�Pot•w�Y We
<br /> hereto aOPlied br and luriher egreee to romove c�ms upon notlte
<br /> �rori the City and lo replace Oublic proporty d�m�ped ihsraby.
<br /> / ' � �
<br /> C ' i
<br /> R CONSTRUCTION AT ACKNO ' DGEMENT OF CO ITIO . .. ,
<br /> �� $z , �.. �
<br /> APPROV A S ED AT SIG R OF APPLI N " �DATE
<br /> I�ERMIT IS VALI FOR 1 YEAR CALL FJR IN PECTION
<br /> POST ON 259-8811
<br /> i JOBSITE 24HRS. BEFORECONSTRUCTION
<br /> EXPiRATION
<br />
|