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<br /> �"`�" APPLICATION FOR PUBLIC WQRKS PERMIT
<br /> � TVPe or orint ciea�ly wlln ink �7
<br /> PRESS HARD•YOU ARE MAKING COPIES pERM1T NO.}'�' ��� �
<br /> PUBLIC WORKS
<br /> EVERETT,WASHINGTON BLDG. DEPT. N�.
<br /> Li OWNER ❑ AGENT DATE .L�_�,?�_—__
<br /> APPLICANT/FIRM REPRESENTED —_����}L�1--G'e��Li—_.���2�- �
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<br /> ADORESS �'���-� '� CITY E[�i'2G�'i TELEPHONE
<br /> HEREBY APPLIES FOR PERMISSION TO �i'4!'../'....it-syJ✓�,�'. /7�r��QJ�� G'�ii;��;�- Si.t7Gi1-�✓ir�c
<br /> ATTHE FOLLOWING LOCATION ����_'-��-= —.13/=�.�'/�QLSLc�-�
<br /> Attach five(5)copies of preliminary plans tor proposed work. Draw to scale and show the tollowing as applicable:
<br /> ' Property lines and street identity. ' Topographic changes requiring cuts and fills
<br /> ' Outline and dimensions oi existing and other than normal toundation.
<br /> proposed structures. ' On-site drainage systems when required.
<br /> • Existing and proposed �tilities. ' Erosion control methods when required.
<br /> • Centerline of abu� ,ig right of way. ' North arrow
<br /> ----- �signelure of Aov��cenl
<br /> coNoirio►�s: PUBLIC WORKS PERMIT
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<br /> � !�._.;. i ..-�__.�..i � � 1...,� 1.� � . � � . � i..�� the City ol Everett trom any en0 an clelms tor damepen, cosle.
<br /> : . . .. . _.. �. , . � ....., � . .. � � 1. .: l-.. eKDenees,or causee ul BCtiJn Ihat mey eriee be[auea ol inelellellon
<br /> � � � � enE meintanence o� t�e Improvement or other tlQM-ol�wey uea
<br /> - hereto epplied for end furtAer agreee!o rnmova eeme upon nollce
<br /> ' � from Ihe Ciiy end �o rep'ece Oublic pmperty demeped theraby.
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<br /> � /1 18-� �
<br /> l VED FOR CONS UCT�N DATE ACKNOW GEMENT O�ONDITIONS
<br /> AP�EDA/�NSTRU� , DAT� SIGNAT�.1 ,-OFAPPLIC�+ T � D���
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<br /> PEFiMIT IS VALID FC�R 1 YEAR pOS7 ON ' � CALL FOH {9JSPECTION
<br /> 259•8811 �
<br /> EXPIRATION JOBSITt 2qHRS. BEFORECONSTRUCTION
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