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`"""` APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYGe or Drint cleerly with ink <br />PRESS HARD • YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. g'Z a" S Z <br />EVERETT, WASHINGTON BLDG. DEPT. NO. 92/1 �Sq� <br />� OWNER ❑ AGENT DATE __4!'�!'ST 1 � Ll �?2 <br />APPLICANT/FIRM REPRESENTED _iQ� �ng Ilooth __ __ <br />ADDFESS °3? NE ilorth� t1 Q Wdy CITY Seattle TELEPHONE '63-0360 <br />NEREBY APPUES FOR PERMISSION TO canv0rt structure t0 !bf1Ut ShOD usa <br />AT THE FOLLOWING LOCATION ?�Lr °1'Od <br />Attach fiee (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />' Prope�ty lines and street identity. <br />` Outline and dimensions oi existing and <br />proposed structures. <br />' Existing and proposed utifities. <br />' Ce�iterline of abutting right of way. <br />CONDITfONS: <br />` Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-site drainage systems wlien required. <br />* Erosion control methods when required. <br />' North arrow <br />Y4�L1i�a�i 1!uoth <br />ipnature ol AOVlicanl <br />` _ �)(y,�,�ivl—' I��C "�i=�.�f'% W141S ��i��''�lii-i'3� <br />� V.J <br />i � � ,,,,-;�l-�,�=�o -- ,,.� ,� --�:i-� t �s--� :., � ; ,;�---,�:�_-��- <br />� �� �N��:'�T�t�—S� � '-�l c� J � <br />� FON./ i_-' -�c.I '.al��t. p.• i f <br />Z,. � f Pase —i-r � i 5 ( j F( � I �-1 1,� ; r <br />ci f c� .�r 5 --(�-w ,... b I cl� . <br />i:.+ � . ; <br />� ' � <br />; ; <br />�_ 1��._� e,.f. <br />__,. � � I ._ a. � <br />, _ �_ ,._�. ;_ :._; _� �—:. <br />1 � , <br />-�- � � t -I..a <br />'i..: <br />� <br />PERMIT IS <br />EXPI FtATI ON <br />1 <br />The untlersigned owner nerc6y aprees lo hold entl save harmleee <br />ihe City of Everel� trom eny an0 all cleims �or dameqe4 coste, <br />Brpen5e5, or Gau9e5 Oi aClinn Ihel may erleE beCauee of InetelletlOn <br />and i.iainlensnce ol Ihe impmvemenl or othe� riphl-of-wey uee <br />herelo eppiietl lor a�tl lurthei aBrees to remova sama upon notke <br />Irom the Cily and to replace public proparty demeped thereby. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />SIGNATUREOFAPPLICANT , DATE <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORECONSTliUCTION <br />