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� _ � __ . _ . <br /> "w APPLICATION FOR PUBLIC WORKS PERMIT <br /> � Tyoe or print cleedy with Ink <br /> PRESS HARD-VOU ARE MAKING COPIES pERM1T NO. / -- <br /> -Y--f'�' <br /> PUBLIC WORKS � <br /> EVERETT, WASHINGTON BLDG. DEPT. NO. - _ i <br /> ❑ OWNER ❑ AGENT DATE �%��. �� _ .� <br /> APPUCANT/FIRM HEPRESENTED _ �,J�E /Y: � I �L �, _ .:':]���� --1:! �= Y-.- - -lG-- <br /> ADDR[SS _,L.�__.:.:r_-:L<-� �CITY. .i!Cf,4:lli�lt TELEPHONE - �` - ' _i <br /> / :' <br /> HEREBY APPLIES FOR PEHMISSION TQ ._!� _Jti1L�-.-- - 1-- --�� -t� '' �:` ;=1_-_`_''`�'�`-�"y"L��� <br /> - - -�.��__!___� L_1_. ,__L._ -- <br /> ATTHEFOLLOWINGLOCATION _ _��'�f_i. __ ��J� _-l='I-_ 'iy�o..1--1=iJ�1��'ILi_L't 74�,�_ <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as appticable: <br /> • Property lines and street identity. ' Topographic changes requiring cuts and (ills <br /> • Outlfne and dimensions of existing and other than normal (oundatfon. <br /> proposed structures. • On-site drainage systems when requfred. <br /> • Existing and proposed utilities. ' Erosion control methods when required. <br /> • Centerline of abutting iight of way. ' North arrow <br /> � � " � , � f�•; <br /> , <br /> .... -- �— 91pneWre ol APOIi e 1--�--��–'- -- <br /> �%. <br /> PUBLiC WORKS PERMIT <br /> CONDITIONS: <br /> � � ; I l�� L��� ll i� n� : ��;i , , � ,� � .-"- �'/.;, �. � ; <br /> ; , , . <br /> � j! ; � � <br /> � ' ' l�r unrf�rsipned owner herebv vgrees lo ho�A onu eave �ernlens <br /> � � Ihe Gdy ol Everetl �iom eny nna eu claime for Aemeye0. [oete. <br /> oapenees,or cauaee ol ecllon Ihet may ariee becaune ol InstolL�licn <br /> antl mainlenence ol Ihe ImO�ovemen� or olher ripht�o�•wey uee <br /> � nerelo eppbed lor entl lurther e8�eee lo remave eame upon nollce <br /> Irom iha CAy end to �cpince public prope�y demepetl IAo�eby. <br /> ppPROVEb F �THUCTION DATE ACKNOWLEOGEMENT OF CONOiTIOIJS � --� <br /> � �i <br /> ,����� 7— � " <br /> pPPRCI D O TR E DATf' � � SIGNAPIhE OF AP�PL�S�ANT , , DA7�- ,. <br /> PERMIT IS VALID FOR 1 YEAR � CALL FOR INSPECTION <br /> POST ON 259•8811 <br /> JOBSITE 24 HRS. BEFt1RECdNSTRUCTION <br /> EXPI RATI ON- — _. <br />