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evcrett qppLIGATION FOR PUF3LIC WQRK� PERMIT <br /> � �)'PB or Print Ue yrly with Ink <br /> PRESS HARD-ti'OU ARE MAKING COPIES pERM1T NO. � <br /> PUBLIC WORKS �' O6 �. <br /> EVERETT,WASHINGTON BLDG. DEP7. �'JO <br /> � OWNER C�+GENT DATE �'�z-- <br /> APPLICANT/FIRMREPRESENTEDJ���« ��� CG • _. — <br />� O. %3oy� 2�f y7 T�M//�1/14-AM�iTY "'��T"/ /�-TELEPHONE�� ry�� <br /> ADDRESS P --� <br /> HEREBY APPLIES FOR PERMISSION TO ��5� GX/SJ7�� �V�A3�7S <br />� / <br /> l ATTHE FOLLOWING LOCATION ���7 %v�a�Dw��f ^ � ��Z e Yd�L�//�f/CLc-� <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicabie: <br /> * Property lines and street identity. ` Topographic changes requiring cuts and fills <br /> � Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. � On-�it drainage systems when required. <br /> ' Existing and proposed utilities. ' Erosi n ontr I m�ihods wh n requirEd. <br /> � Centerline of abutting right of way. �rth rr w � <br /> � sl�wre ol AnP��cant <br /> PUBLIC WORKS PERMlT <br /> CONDITIONS: <br /> T I 'y�'�- I I I � <br /> _� <br /> _ �.�. +- r- -� - - + t _ +* i <br /> 1 � i rt � _' - <br /> � . - t ��: ��' I � . <br /> �"' _ <br /> .♦ - ♦--. y- � <br /> �1 �_'_ �-..-i- ���- ���} - i <br /> � j ' - i <br /> - i <br /> � <br /> _ i �I �, - _.1_,-� <br /> —r� <br /> � � <br /> � � i <br /> � , i � <br /> -- _;__� �i , _ � <br /> ' r�'-i r- - ---l. '� -,- <br /> -.-�: <br /> _ ' .�� l�- � �� � _ <br /> « � �� � reb e rees to holC,end save��armless <br /> The untlersigned owner he y 9 <br /> - �"-1"� � �- �he City oi Gvorett Irom nny entl au clalms lor dameges, cosin, <br /> �1- <br /> t i. expenses,or causes ot actlon ihal may erise beceuse of Inatellellon ; <br /> � 'i antl main�enence ol Iha improvement or o�her riqh4ol�way use ; <br /> hereto applled br and iwl�er agrees lo removo 6ama upon uotica <br /> Irom the City and lo replace public proporty dnmaged ihereby. I <br /> � <br /> � - � z' e, � <br /> � PPROVED F O TRUC � DAT� CKNO L G NT F CONDITIO S , <br /> c�� i' � r <br /> � ��_ %�- 7'c�� <br /> ABeAQV S N TRUCTED DATE GNAT EOFAPPLICANT . TE _ � I <br /> PERMIT IS VAl�ID FOR 1 YEAR CALL FOR INS�PECTl�N.` � � <br /> POfiT ON 259-8811 � <br /> JOBSITE a4 HRS. BEFORE CONSTRNCTION i <br /> EXF�IRATI09U. � <br /> " I <br /> � � <br /> I <br />