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�;��- - .x= ii�y.� <br /> w APPLICATION FOR PUBLIC WORK5 PERMIT <br /> � Type or prinl cleerly wlth InM �/ <br /> PRESS HARD-YOU ARE MAKING COPIES pERM1T NO. --�`�__�'t— <br /> PUBLIC WORKS <br /> EVERETT,WASvHINGTON / BLDG. DEPT. NO.___---- <br /> ❑ OWNER q� AGENT DATE _��� � �-� <br /> '` I - -------- <br /> APPLICANT/FIRM fiEPRESENTED �L� /�/Gl�' �r,�� I ` ��, <br /> ADDRESS �1X1���- � L��f—_CITY(..�v�'��/ E ELEPHONE� ��Q <br /> HEREBY APPLIES FOR PERMISSION TO _ C�AIS�ZI�]!J-�/��-- <br /> --��"DPpI-A�.�z_.�T�--� --------- --- <br /> ATTHEFOLLOWINCiLOCATION _._—__—�G�4�_—.-..����1_-!_2�1—JSfL_— — <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show lhe following as applicable: <br /> • Property lines and street Irlentity. ' Topographfc changes requiring cuta and fills <br /> • Outline and dimensions of exlating and other fhan nor I found�li6ri:� <br /> propoaed c�tructures. • On-site dra a s te when quired. <br /> • Existing end propoaed utilities. ' Erosl t whgn re uired. <br /> ' Centerline of abutting NgM of way. • No h � <br /> � i /� %% <br /> - — lu al APPII �' <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS; <br /> ; �k- /�� ����r�l�l.> fL�i/tJ�J' ��v��' <br /> i� �F /, C"u/'��' . ��. f'�I�"`rLiC� /��fT'•^'�' '1 ci�c��iC's-� 7-'J . . <br /> J <br /> �-�,.�Gc.�� C,Jv.e,EJ' �.J ��'/��_ <br /> `.3 Jf- /���'f��,CYIi@�['t �'s� �"�/��+��c� �� � � ✓T� <br /> .�y�,�,�,� � .�-���.��� �'y ��-y� <br /> O,P .s.Z'f' r�"/ '�C� c5�-"L�.�' `-<'"-` c5'� �.�Ss�G.�'�C7. <br /> ' ' ' '-' ' � � � � � Tne unean�pnee owner hereby nBraea lo hold end eeve hermleee <br /> ' ' Ihe Oty al Everell vom eny nntl nu cielme lor deme0es, coel�, <br /> � e+veneea,or ceuees ol ection I�n1 mey etlse becauee ol Inetdl�llon <br /> end meintenence al the Impmvemenl or ot�er riphl�o4w�y u�e <br /> . �nrelo epplled lo end lurt�er eQ�eee�o remore same upon nol'ce <br /> �–. Irom Ihe City to eplece puDlic p perty damapeO I�erbby. <br /> ��� __i� � 7f��.' , <br /> AP VEO. OR CON THIi TION DATE A� IVI � T C�NOIiI S 1q� <br /> � � I I�).. / ��. . % �v �� ' LL� <br /> � �Lf' S 1 <br /> APPROV NST TED 0 TE � S� ATURE- �A���CA DATE <br /> PERMIT IS VALI FOR YEAR pOST ON CALL FOR INSP�CTION <br /> 259-8811 <br /> EXPIRATION— JOBSITE 24HRS. BEFORECONSTRUC710N <br />