|
f'
<br />-:.' y,r .� � d H.�';" � � x� �'� '4[e�y''P�2�P � ''_ '
<br />]��, i: %�a . a y�8„ .�7 g r.
<br />I—'� S �4tf ^� � ;�t
<br />�(' A�� .,. � 4,
<br />. ' e�^ Y..1Y`h M 't."4 u R n
<br />. . ... . � tYy�r �+,$ ^4 , .... .. . ..
<br />everott
<br />r � APPLICAT�ON FOR PUBLI�C 91VORKS PERMIT
<br />Type or 0���� clearly wilh ink
<br />PRESS HARD • YOU �1RE MAKING COPIES
<br />PUBLIC WORKS PERMIT NO. �� ' ��p
<br />EVERETT,WASHINGTON
<br />� OWNER ❑ AGENT DATE J� _:�=g J_ BLDG. DEPT. NO.
<br />1
<br />APPLICANT/FIRM REPRESENTED __ ��_Y 1 t�� r��C�,��_�
<br />(1I
<br />ADDRESS '7i� � � '� - `-� � -,�-s.Y ��l � (,�J C�Ty �����TELEPHONE �:i5 - G � `�.,
<br />HEREBY APPLIES FOR PERMISSION TO ��.� ._,.o � e i
<br />/ tr.�' %�% //%C/-��Z� .S�
<br />� �.
<br />AT THE FOLLOWING LOCATION S-
<br />��
<br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the followiny as
<br />' Property lines and street identity. " Topographic changes requirinc� cuts and fills
<br />' Outline 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 />' C�nterlire of abutting right of way. • North ar.ow
<br />_�; �
<br />_ c�� -� � �
<br />�� —/. s ena�� orx�ouoan�= -, �`�—b
<br />coNoiTioNs: PUBLIC WORKS PERMIT
<br />D ��l �y ,'�? [7. Lc� C,.�,c < .✓a,- ,o c i�;/',c'ol�i� T:a :��� � ;:�-;. �.
<br />�:Ty .5���.,�F/�'fZ3' .9/+�� C.ry o.�i� c 7-/7�,.�cF�.f'c i�
<br />/t/oi n?sji�+1TA//�% TiY= AiLEfi s�.E'fi9c'c`e
<br />��� �'9.C':S' c�.���.G /✓�T ct�c cLc?.JC,p � ^>
<br />9 i� vlf/f'c,,�" oiilT'j
<br />��,e�J��w�y - ,9«Fy �-� ���c ���� �-o,��,
<br />ii✓c,�'r.Ss h'� Ec�,<'�s�r d�6y�.F'-���"� �'�v�7�'�cTt��
<br />}_, _ CciiC'� � � �'��' i .a �
<br />. �--._,.� �:�......_„/ <t s �'ci9� .!1'c i .>c .�-cr �
<br />i. c�J•f����y /,�N,� �n.E'o�j��.tq.... � ,
<br />-: .� .�,,,.._.,.�...
<br />,,,�� ��, i
<br />' { � .� .. i . . � � i i ; ' -_l�..�._.
<br />... . I .A__ �' i �'_�J` 7��
<br />. . , . ' . � -t^, ""_ ..
<br />, .. : . . . . _ _..._,.�_.+-...
<br />: . : � �, � . , . . . _. ., . ,._.
<br />/�7 __. � .. �. � /. � .
<br />�� . �-� �. �I� r ���! �� �
<br />AP .f}OVE� p Fp CprySTRUCTION DATE
<br />(
<br />� � � � i��
<br />APPROV� CON5T�7 TED DA E
<br />PERMIT IS VALI FOR 1 YEAR
<br />�XPIRATION
<br />L
<br />.;;;..
<br />Tha unCers�gnetl owner hereby egrees to holE end seve harmlesu
<br />the City ol Everelt trom any eno au ciaims lor dame0eq cost0.
<br />expensns, or �yuses ol aclion ihet may eriae bacauae ol inatalletlon
<br />and mainlonance oi the Improvement or other riphhol-wey uee
<br />herolo oppllotl Im end Iurlher agreas to remove sama upon noU�e
<br />Irom Ihn C�ty and lo replace public property demeOeA thereby.
<br />� c�.
<br />A�yNO':IL� EMENT�pF EONDITIONS
<br />��%`� � �I��,�-��� ���-i- � �-
<br />SIGNATUREOFAPPLICANT DATE
<br />POST ON CALL FOR INSPECTION
<br />JOBSITE 259-8811
<br />24 HRS. BEFORE CONSTRUCTION
<br />.:.�
<br />i:::
<br />�
<br />
|