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. everett APPLICA�. �ON FOR PURLIC WO. .�CS PERMIT <br /> � TYPe or Print cleady with ink . . . <br /> PRESS HARD-YOU ARE MAKING COPIES pERR�iT NO. <br /> PUBLIC WGRKS <br /> EVERETT,WASHINGTON 'j BLDG. DEPT. NO. — <br /> ❑ OWNER ❑ AGENT DATE ��/�1�L S <br /> APPLICANT/FIRM fiEPRESENTED �/�C ��V_�1�I,�__L��/�='�c . <br /> ADDRESS _� .3�7 � �E cirv �eaN�c TELEPHONE3.��"3`��� - <br /> HEREBYAPPLIESFORPERMISSIONTO �O�/�TE /Q �U�q�STEK OiV TNE <br /> S/]�F(.vALK YOiC � �tlT-F �' S <br /> AT THE FOLLOWING LOCATION •3 0/S C D L B �_ A VE — <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the following as applicabie: <br /> " Property lines and street identity. ` Topographic changns requiring cuts and fiils <br /> ' Outline and dimensions of exisiing and other than norr,ial foundation. <br /> proposed structures. " On-site drainage systems when required. <br /> ' Existing and Froposed utilities. ' Erosion co�[rol methods when required. <br /> " Centerline oi abutting right of way. ' North ar;ow <br /> Signature ot AOG�icant <br /> PUBLIC WO�KS PERMIT <br /> CONDITIONS: <br /> i <br /> ,-� - . <br /> � r-�- ' --�- �«-� L ' - `- � � i <br /> � t _ I `J -,.1 1 1 I I � � ' I , . _ � <br /> ' �y -*r-- -�'-+-'- -t � -'--t-+- <br /> - - -' 1 <br /> -- - i <br /> � 1- . i_l�_ '� -1�: <br /> - � + - i � L . _: - <br /> � �_i_ - <br /> � - *~ � t � <br /> - r -�+ i...._ -j-� } �. . ' - i i-:� � '�i� i <br /> . � ; <br /> _ ��_ _r ±� rtl_: _r� { ll ��. i <br /> � � �1 ._._�. ��- ,_�- ��: �� ♦ i <br /> -L --1- � . +- . � <br /> � , � -'-- -• -{ -• -t •- � <br /> _ -��_ _ }-'- -i-- �-- • �, 7- - i-i - �- - -•-•-+ <br /> -. -, -� � -+- -_ i - - - - +-�- -;� -�-'--r <br /> i _ <br /> _ � The unOC�signed�owner hereby agrees ID hold,end save harmle55+ <br /> �t _ _ _ _ ~ ~ Ihe City ol Everett trom any antl au claime for tlemages, costs, <br /> � �_ _ _1. �._ ezpenses.or causes ol actlon tha�may enac beceusr ol inatalletlon <br /> and mainlenence ol iho improvomenl or olhei �ight�ol-way usa <br /> � � --�—�-�- hereto epPlietl lor an0�urt�er agrees to remove eame u0on notice <br /> i t � <br /> Irom Ine Ciry an0 lo replace puhlic Oropetly damaped ihereby. <br /> L f, -1� <br /> , '`4 �APPROVED FOR CONSTRUCTION DATE ACKNOWLEDGEMENT OF CONDITIONS <br /> APPROVED AS CONSTRUCTED DATE SIGNATURE OFAPPLICANT DATE I <br /> CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> EXPIRATION � ' `' ' '' I '.: �'.-- JOBSITE 24HRS. BEFORECONSTRUCTION i <br /> 1 <br /> 1 <br /> � <br /> f ' <br /> ! 1 <br /> J <br />