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,_. <br /> i � <br /> eV""` APPLICATION FOR PUBLIC WORKS PERMIT <br /> � tY�e or Orint cloarry with ink / <br /> PRESS HARD•YOU ARE MAKING COPIES �� "3�� <br /> PERMIT NO. <br /> PUBLIC WGRKS p� <br /> EVERETT,WASHINGTGN BLDG. DEPT. N0.9�� 9�� <br /> �OWNER ❑ AGENT DATE <br /> � .SeoT_c°,Z. <br /> APPUCANT/FIRM REPRESENTED <br /> � - ,TH �- - lG'/fo�1v,�C---�leoy� <br /> ADDRESS J1�� ' 3�T��,�/� CITY �S_E}�J'��TELEPHONE �1�-j0� <br /> HEREBY APPLIES FOF PERMISSION TO <br /> ATTHE FOLLOWING LOCATION �OfS--C�0���7—_t-Y_V�. <br /> Attach live(5)copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br /> ' Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> • Outline and dimensions o( existing and olher than normal foundation. <br /> proposed structures. ` On-site drainage systems when required. <br /> ' Existing and proposed utilities. ' Erosion control methods when required. <br /> ' Centerline ot abutting right oi way. ` Nort w /J <br /> S�p� APPhcen� <br /> coN�moNs: PUBLIC WORKS PERMIT <br /> OC'C u/'f,��c y /���E'�yJ/T cN/cG �'F /�«.O �'Cn�✓>/n�G <br /> �f%'`J`oGUT/o� C>F �'c, NZ�✓T/n� L C � �G� /.l�_ /r'� <br /> 1 <br /> f'�� T«,f'c� /�ilo�'t.iC' �'FF -.S�'Ec=i /%��E'�'inJG .S'�'aCTu�i'E> <br /> �%r /-_in-'/I� �nE'<<i°.C'/'��r.� _nC No N -SiG n�/Fi�i9.�C E i4`79-/S!/ <br /> -� �c-P oFr- -n-K- . sr��-w+�c.�, <br /> --�-`��-a--._.j �. . . <br /> �_._L,_:_. � i-� -. <br /> _. ; � <br /> } _ �, __ __ . � . _ _ ,_ : . . <br /> I_' ! -' ' i �.�yi 1��� . !y ` :1�� �' ' ' .� <br /> � _ ,� �..-t-I - �' . <br /> N ' i l_r � <br /> �� � -`-.�-^._..,,_� <br /> .�-,�_ � � �-�-_...;.. <br /> i_. : <br /> � �� I ( � I � I�� . � �� , 1� The untlereignetl or.ner hereby aprees lo hold and seve hermle�e <br /> ; t ; ' .' _ . �, * . — <br /> . , � , . . . . , ,_ _,.� the City o� Everatl rrom eny ena an cleime for deme0ae, co�ls, <br /> � -- - ,—� e�pe�ees,or ceueee o�actlon Ihet mey eriae beceuee ol InetellNlon <br /> ' ' � � � end maintenence ol the Improvemen� or othe� liqh��ol�wey uee <br /> Aerelo eoP��ed lor end lunhar aqreen lo remova eeme upon notice <br /> /- , from the City end to replece oublic p�operty demeqeO thereby. <br /> / `� l.,� �/v ��,7 v r� <br /> ROVED F � ON RUCTIO DATE A WL�GE ENT OF CON ITI� <br /> �,��r_ �l�— r.�. '= -�—�,;�1��� <br /> OV D AS CONSTRUCTED DATE GNAT E O AP LIGA ATE <br /> P�RMIT IS VA�..ID FOR 1 YEAR pOST ON CALL FOR INSPECTION <br /> 259-8811 <br /> tXPIRATION JOBSITE 24HRS. BEFOREC01�5TRUCTION <br /> � <br />