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� <br /> r '� <br /> everett <br /> � APPLICATI( :N FOR PUBLiC WORKS PERMIT <br /> Type or print clearly with ink <br /> 1RES5 HARD•YOU ARE MAKING COPIES <br /> PUBLIC WORKS PERMI7 NO. �� .3 � " <br /> EVERETf, WASHINGTON A <br /> ❑ UWNER �] AGENT DATE �__J_.�]_,V Z BLDG. DEPT. NO._�a,� � <br /> APPUCANT/FIRM REPRESENTED _L�(�_�� up�}���� ��ow <br /> ADDRESS r � <br /> -�'��-1$--�- cirv �.�-- <br /> 7ELFPHONE_�_ <br /> HEREBY APPLIES FOR PERMISSION TO _ <br /> CO/.ls�� /n�. U�t/�5' o F <br /> --.�L�E�t-�_J�oy_EC�_��f�ir6/�e ,P. u, w � P � .�S <br /> i -�^' �O��ir��o�r s P� <br /> AT THE FOLLOWING LOCATION �O 20___��p a���/ �� 3�i ns��S <br /> ( � I <br /> Attach(ive(5)copies of preliminary plans for proposed work Draw to scale and sho�the tollowin as a 1 <br /> 9 pplicable: <br /> ' Property lines and street identity. ` Topographic changes equiring cuts and fills <br /> " Outline and dimensions of existing and other than normal bundation. I <br /> proposed structures. * pn•site draina e syeems when required. <br /> " Er.istina and proposed utilities. * sio con meGo hen re uired. <br /> ` Centerline of abufting right of way. North rr � I <br /> — — ' <br /> SignlureOlAppli�ant '-�— <br /> PUBLIC WO S PERMIT � <br /> CONDITIONS: I <br /> �- + --1 �_� ' 1_ ;�� � <br /> - r �i 5'Sty � ,��7 4�m i'f �,_i �-p � '_"f '' *�' <br /> f� ✓, <br /> �, _ �T� _.._•—,-... � � <br /> ,,f,t -�—� <br /> , <br /> _ ,�- ! � <br /> -�'�I � ; , ,P -�- —.. _ �� '�ci:_ _� �� <br /> '.-f` . -1- . '' _: 1_ _ � + �-- <br /> - � -� 1._ ~ � 1 � '. . i . �-' i <br /> , j< -�- . _ .�1 _ 1_f' _ _ -:�-' t :,, <br /> - - �1� -l-+_� I � ��-r. _ �+� M� .irl__ --% . c:/.. .:i .vl. J�r.i { <br /> . � � -/-��..� _i_ _ } ,� Y- � �-� '�� j . /�-t- U 1 � . ? �/ �,/�-i <br /> { i _ <br /> I ' "'-'"-'1 _'_i _ ' .:-.�'r1..5 -./#/ -�S-C� �•� , -i-+ � <br /> _�� ��,. ._�- :� - � : <br /> '-+ � � �- _ _1_ ; � � , . .� .o. _;�-�; ._{ .; � <br /> - -� - - � �.:_ . . . . . , _�_. �1_�_I <br /> � . . - - <br /> , . . <br /> ! _ <br /> - - -i - - - � � - - , ; . .' �, . . <br /> � - -{-._ _ - -, t � � , � � _ ' 1_ <br /> - � - _ �� '-� ��� T� <br /> � � _ � , -�- ' The untlersgned owner hereby aprees ta hold entl save harmlens <br /> - -- �hn City o� Everelt trnm eny ano eil claims br demaeee, coats, <br /> -1- . exDenses,oi causes ol acllon ihat mey arise beceuse ol Installetlon <br /> 1 <br /> end meintoaance oi the imOrovement or other riphl-of-wey uae <br /> - ' � ho,reto eo0lied lor and lurlher aB�ees lo remove seme upon nolice <br /> - - -` (rom �he CB enA lo reo�ace <br /> . Y public property damaged ihereby. <br /> �- PROVED FOR QONST��pry /G� r �� r <br /> ATE ACKNO LEDGEMEN70FC DITIONS � <br /> � %�G�: �{��u- z -1 -� �,�2�1 h-'�� -01 <br /> APPROVED AS CONS7qUCTED DATE SIGNATURE FApPLICANT DATE <br /> PERMiT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> EXPIRATION�__ � JOBSITE 24HRS. �EFORECONSTRUCTION J <br /> L <br /> � <br />