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_ .` <br /> °"°'°" APPLICATION FOF� PUBLIC WORKS PERMIT <br /> � TYPe oi orin�clearly wilh ink � � <br /> PRESS HARD-�'OU Al1E MAKING COPIES pERM1T NQ. �� ' <br /> PUBUC WORK5 I <br /> EVERETf,WASyINGTON BLDG. DEPT. NO._— —_-- <br /> �OWNER ❑ AG=NT DATE �.3-�y -� <br /> � '/U/V/5_!r'i��L r _ - -__ ----- <br /> APPLICANT/FIRfd REPPCSENTED �— <br /> ` r��' �'Ic u <br /> ADDRESS ��� � '���C��'���� J CITY L` l�C./–LTELEPHONE <br /> 4FREBY APPLIES FOR PERMISSION TO �( Cr��� ��u� —��lj� �C C�L Z <br /> ATTHE FOI_LOWING LOCATION ��� �����»�J���---- <br /> Attach(ive(5)copies of preiiminary plans for proposed work.Draw lo scale and show the following as applicable: <br /> ' Property lines a��d street identity. " Topographic changes requiring cuts and fills <br /> " Outline and dimensions of existing and other ihan normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed utilities. ' [rosion control methods when required. <br /> " Centerline ot abutting right oi way. ' Norih errow <br /> , <br /> ,�l,i,Z.L-� _;�gu c,. ----- <br /> �-- � � Si naturc oi AppliceN <br /> PUBLNC WORKS PERMIT <br /> C�SNDITIONS: /, <br /> � / �f �//T/�/GG � 'SC'O!'�C° /NOril.' L p�(� r"Y'd.��. <br /> . . �!Y/ P $�lA// / <br /> /,�. <br /> PUPfy s � <br /> / �^ ��iv <br /> , . �/0/�,4����'. / t 1`� 6P A //uwrrS- o .-,AGa ., t_ , <br /> �-:-. - J � l / <br /> , I � . . ��rAs bP/7in� f'��.f�jv�C 5/ rw .. IE' S er., � �, <br /> � 51 �-i, ,-h 6ti �_,.-t•i�t%. <br /> , �.:7,/ �.�< 5/ frfr'd R'� r � <br /> t � <br /> I <br /> :-. : : : J <br /> , . . . . . . . . � � � � ' 7he undersipn=d owne� hereby �Prees to hold and Fave �annlees <br /> � � ihe City ot Ever?tt b:m any unn an Uaims for damaBes, cos15. <br /> � � orp�nses,or caupus of act+on that may erise bec+use of instellaf on <br /> � and meiN�nenc= ol tr�.� imnrovemenl cr other righPohway uae <br /> � ' ' hereb aCD��etl!or end tu�iher aprexs to remove seme upon nolice <br /> � <br /> I imm the Cl�y and to replace Ou61ic V�operty dem�ged �here y. <br /> � �1+— i <br /> --��-� / �__ \ _ _ <br /> , <br /> i ��`t_' � � �----- ACKNbWLE�GESMENT�PCOM1DITIONS <br /> � "�I!PP OVE OR GONSlRU TION DO,fE J - <br /> _ �, � - , � ,, � ,� _ -._ l� �" `L <br /> W(� ���-3i� gZ." `'�'-L'(t1._i_ t_. � ��-�_ <— <br /> S'GNAfUFEUFAFPCI�AIJ� DATE <br /> A7PRUVED AS CONST�RU TED�_ n��TF ' <br /> PERMI'i' IS VALI FOR 1 YEi�R CAI.L FOR INSPECTYON <br /> PrJST (3!� 2�a3-8811 <br /> JOBSITE. yQ �Rg, gFF�RECAr�STRUC i ION <br /> E}ip�p�TION - — <br /> ' '- - - <br />