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r <br /> C <br /> 1 <br /> °� APPLICATION �OR PUBLlC WORKS P�RMIT <br /> Type or pr'r.t clearly wilh ink <br /> PRESS HARD•YOU ARE MAKING COPIES U <br /> PU81_IC WORKS PERMIT NO. D3 S �� <br /> [VERETT,WASHINGTON M �� p <br /> O OWNER ❑ AGEN7 DATE /ri/}-�G(j_ `J_�� �7 �� BLDG. DEPT. NO._ _ <br /> APPLICANT/FIRM REPFESENTED _ST__P/J'�.I�-___N KlT�O __���_o��J�c f�,.�__�,�,�� <br /> ADDRESS Q n ��-/Qy (/ <br /> •-� CITY TELEPHONEa-�1—�'�/yr/ <br /> P��� 7 <br /> HEREBY APPLIES FOR PERMISSION TO _/1LG_�/�-�X/N �. S��Ln , <br /> AT THE FOLLOWING LOCATION �U��-- C G�I��' <br /> Attach tive(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> ' Property lines and street identity. ` Topographic chanpes requiring cuts and fills <br /> ° Oulline and dimensions of existing and other than normal foundation. <br /> proposed structures. • On•site drainage systems when requirP.d. <br /> ' Existing and proposed utilities. ' Erosion control methods when required. <br /> ' Centerline of abutting right of way. ' Nort row <br /> ��'�' . neNre ol DLcent <br /> coNoirioNs: PUBLIC WORKS PERMIT <br /> ��-�� � r ;_� : (� � � , <br /> t \l '1 .J �-_... <br /> , <br /> , ;_ <br /> ;,, <br /> ��'7�_' P G � ����,� � }��'� <br /> � -.�-r_ �v�� -/ +'1\G ��` CL ��, <br /> �� � I - � \� �� �.�, �� <br /> �. ; ' -` V� �,�'`� ��� ,r �� �r <br /> � � , � � ,,.. ,- �" �; �� <br /> �,�T �� � _U �✓ .�.P14,.� l(e � I� \ . <br /> � ��. ._ ` ``\ ,�., <br /> _A. , , , v- ¢ i .r �.� r , <br /> ' � �.�/ � ���% �� �� � ��� � <br /> , p � <br /> � � � \`� / (�.� rS `Y-�\ \SZ/ � �O <br /> G` �y, <br /> ��'� ,�e�`� � ��J / <br /> � -� � � � The untlersigned owner hereby aprees to holC antl sava harmtess <br /> \ • 1 +-} •� the Ci�y ol Everetl trom any anC au clalms for tlamapes, conts. <br /> \�� � � , �"L' F }- expenses,or causea oi eclion Ihat may arise because ol Inetelletlon ' <br /> _"" J_ .. <br /> � -��- . � }""f anA mainlenance ol Ihe �mprovemenl or other riphlrol-wey uee <br /> .. ...... , _'�... <br /> . �, ��� ���j� � 1-'�"� a � � he�eto applled lor antl lurther agraea�o remove same u <br /> - . . . , .: pon nolice <br /> . ... ... . � „ Irom the Cily and to replece public property demepad thereby. <br /> I APPROVED FOIi CONSTHUCTION DA7E ACKNOWLEDGEMENT OF CONDITIONS <br />'I <br /> APPflOVED AS CONSTRUCTED DATE SICNATURE OF APPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FGR INSPECTION <br />' POST ON 259•8811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION <br /> L a <br />