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_ ' <br /> , <br /> �everett ppp��CATION FOR PUBLIC WORKS PERMIT <br /> TYPB or Print cleerly wilh ink / <br /> PRESS HARD•YOU ARe MAK�NG COPIES �,' '�_/�_ <br /> PUBLIC WORKS PEFiMIT NO. t?`� � � � <br /> EVERETT.WASHINGTON BLDG. DEPT. NO. <br /> �.j OWNER ❑ AGENT DATE � '_�ff�(/�_$�, ' <br /> APPLICANT/fIRM REPRESENTED __���______��rJ�, J,L� �,��y�o� _�� <br /> ADDRESS �[��=�3�T�_f��� C�7y. �FhTTL�_TELEPHONE��-ZAC✓J <br /> HEREBY APPLIES FOR PERMISSION TO �n/�-���__�_j7 y���l-FR �N 7-�� <br /> .5�.1��yYh-1,1�-_.-��R��---F1�-�E.L�S_ <br /> ATTHE FOLLOWING LOCATION ,�D LS �Q� Y �V�_ <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the tollowing as applicable: <br /> • Property lines and street identity. • Topographic changes requiring cuts and filis <br /> ' Outiine 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 /> ` Centerline of abutling right o( way. ` North arrow <br /> ,!' � /J ��/.� <br /> Y--L2��F-L—-/__/��3:f��5 <br /> �� Signature ol ApPfcent <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> �y� � L4-i L��� 'j.J�- , ;�` - + ' t �'. � <br /> -�-1- - � - -� - J !- _ _ #� �{ <br /> ' � i -- <br /> � � � � � <br /> ,� � ; - -- �:_ � � +_.� �. <br /> ; _ i �� - -��J� u� �s�t �_ . - <br /> ; •-�• -,--•- --�-r �� , , -. <br /> � , � <br /> � � _ �-{_ �� _-,J. _ � �-._ � � -!- , r�� ; - , rJ_ � r4�1 <br /> - i <br /> � �l_ _ � � _ <br /> )' - � - � - ; � J- ' �-1 G: �s� <br /> - , <br /> ' + - + _ }� , � � �� <br /> �- _._ � -1-1- '' }�} ;� � _i <br /> '- - � :�, .�_ -, 1 - -�--�- <br /> -� <br /> � � , � -�-t- �1 ' . �� 1_i- -. �_' . J <br /> -�. .-... , � ;_{ . i �-J_ }�1- �-�-. t :.� <br /> � I ' - - •-{-� -�_+- -=+ , <br /> y ' � <br /> -�--I �-{--t_ - - - - - -'-��� �.. - � •- --- -�_1 . _:_i� � - -- - - - -�-�- <br /> - � } - - - — � -+-� � � <br /> _� 1- -:- J� i ..f-1'_ � ! _' A .a -�.- ._ . . .. ._ , _ _ ' ._ -t-� <br /> '_ I , _ ' _ _ _�_ '_ . J._ . . <br /> ' _. . .._ _� �_. .-.i . . � _.. . . .. .-.. ..�._1 � <br /> I r • <br /> -`1 f- -1I-�I _ -t -1 � ,4w.�- The undersigned owner here6y agrees lo hold ena seve harmless <br /> "�" � 1� - -'!--{ - - -1 - - �- �- i'--+- tho Clly ol Everell irom any ana ail darme lor tlemepea, cosis. <br /> � �1 +-1— expenses,or causes ol aclion that mey eriae becauae ol insiailalion <br /> � . ��� i i � I � antl mainlanance ot Ihe Improvemenl oi other riph4ol�wey use <br /> -J.-�_ __�_t . � � �-: -� - -}-y- herelo applled�o�en0 lurthar eBrees to iemove same upon nollce ' <br /> � _ I �? � 1 : 1 `?-j- Irom the Clty and to replece puUlic propoOV tlamaged ihere6y. � <br /> // / � <br /> 1 � A�P O ED F R��ON�TION D T� qCKNqW�C-iSG ENT OF COND1719NS - <br /> �; � � ) .� � �l - /, j," <br /> ' ��`��....L';a C '�..._ _ ?-� IVz" ��b�-_-`� / "$1���'"� / -r1,i�r' I <br /> AP�V[�AS CONSl13U4TED DATE NAT APPLICAN�� DATE �� <br /> POST ON CAL:. FOR INSPECTION I <br /> .� �r.< « � `j � Z- JOBSITE 259-8811 <br /> EXPIRATION--!`_—� 24 HRS. BEFORECONSTRUCTION I <br />