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everett APPLICATIQN FOR PUBLIC WORKS PERMIT <br />� TYOe or Print cleady wilh ink <br />PRESS HARD - YOU ARE MAKING COPIES p <br />PU3LIC WORKS PF.RMIT NO. o'Z a 5' S� <br />EVERETT, WASHINGTON BLDG. DEPT. AIC�.—.__ <br />�OWNER ❑ AGENT DATE _ _ � I � '� _ � <br />APPLICANT/FIRM REPRESENTED _ _ I � 7� __ — �_�_ �v%v� <br />ADDt�ESS _ __—___. _CITY __ TELEPHONE __ <br />HEFE�YAPPLIESFORPERMISSIONTO __ vS��— �%C�S?I�II L �.��UtWA�1/ _ <br />I <br />ATTHE FOLWWiNG LOCATION ____ ������ b �- �/�-1'�-�IC v _ � ����`�' _ _ <br />—�----�---- <br />Aitach (ive {5) copies of prelimii�ary plans for proposed Nork. Draw to scala and shaw ihe following as applicable: <br />` Property lines and street identity. ' Topographic changes �aquiring cuts and fills <br />' Outline and dimensions of exisling and other than normal fuund�tion. <br />proposed structures. ' Un•site drairia�e systems when required. <br />' Existing ard p�oposed utilitie:�. ' Eresion contr�i methods wj� re uir . <br />' Centerline of abutting right oi way. ' Nort ow > y�� I <br />/ � <br />CONDITIONS: <br />; j <br />��Y - <br />1 <br />L..l._� � .._ I :...-.. . <br />i � � <br />�,_i...� . . ... <br />. . .. �-."�. LJ...L-. <br />...;_� '. . . .. <br />PERMIT IS VALlD FOR 1 <br />EXPI P.ATIO�E <br />----`-��-> �Z��,i_�} �y�.CCCr.�� <br />Sipnature ot App�icaM <br />PIJBLIC WQRKS PE��MI'T <br />—r <br />'he un0ers�gn,eA owner hereby agrees to hold and seve harm�eas <br />I�e Ci;) o� Eva/CI! IroT 'iny 0:i0 JII ciaims 10� AnmBpCS fO8I0, <br />en.iens!s, ur causes ol achLn 6�a1 m3>' anso because ol ns.ellallon <br />antl maintonance of the impmvement or ot�er riphl-ol�wey use <br />he�eto np0liud lor 0nA `urthe� aprees to remove sema upon i�otico <br />from the City end to o-�pLce puhlic proparty tlemepad Iheraby. <br />�� � � � <br />!_, A yTOWLEDGEMENT F.C.G f(O�� <br />, _ _, � � � . . �� � <br />�,����_ ,�„-r�- ., , �2_��5�-� <br />TE SIGflA1�U,REO.°Rr'E'LI ANT" DA7EI <br />� (:ALL FQC� INSPECTIONS <br />n0�'i `�N 259-88i 7 <br />���{= �TE 24 HRi. BEFO�!iE CONS'�Fif1GT+ON <br />C <br />