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0 <br />0 <br />everctt APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYPe or Print clearly wilh ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON �,�, BLDG. �EPT. NO. <br />❑ OWNER � AGENT DATE _L � 1� -��� <br />/ <br />APPLICANT/FIRM REPRESENTED __._L / � ! �"/— r�`v� ( l��_� > <br />: ] � <br />ADDRESS/"n�'.;�� 'i'� /f-'fl✓��� LJ _��7y ��MC.f D��TELEPHONE 7 � <br />HEREBY APPLIES FOR PERMISSION TO - <br />, <;���!'- �/ , ' ;/ <br />, .. . �Ss�'Md� /r_:-,��E' r o_;� <br />AT THE FOLLOWING LOCATION ` <br />Attach five (5) copies of preliminary plans for propos'ed work. Draw to scale and show the following as applicable: <br />' Property lines and street identity. • Topographic changes requiring cuts and fills <br />*�Jutline 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 />' Centerline of abutting right of way. " North arrow <br />. \� \ ,1 j <br />V i' �./ � � .1 -. �i <br />CONDITIONS: <br />S�•}��c�G� ��F <br />� �T �Z <br />�:.� <br />;,, <br />�� i..; <br />1 �. ! . <br />.-i l � �- <br />`1; �' �? ��- <br />' �� <br />_���� �/,�� ��� <br />PPR V FOR CO� UC ION DATE <br />— �.� .% c, , <br />. -.ys, �,. ;/� �- i'. �- if � <br />APPRO ED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1.��� I pOST ON <br />EXPIRATION z/��'� JOBSITE <br />L <br />`�.��COv�' � <br />l��•7��j <br />The undersigned owner hereby aB�ees to hold antl save hermless <br />�he Clly ol Everett irom eny ano aIl clalms Por damaqe0. Coels, <br />erpenses, or causes ol aclion ihal may arisa because of inatellallon <br />and meintanance ol Ihe improvement or other ripht-oFway uee <br />hereto applied lor and Iwlher ag�ee9 to removo 9ame u�ron nollce <br />Irom the Cily and lo replece pu611c property demepetl Ihereby. <br />OF CONDITIONS <br />� 1 n <br />�� <br />CALL FOR INSPECTION <br />259•8811 <br />24 HRS. BEFORECONSTRUCTION <br />'; h r r.'a �.�.:� �'r,� v.r a>. �,.> . . . . . . _ - <br />� <br />J <br />