|
_ i
<br /> "'°`°" APPLICATION FOR PUBLIC WORKS PERMlT
<br /> Type or print clearly with ink
<br /> PRESS NARD-YOU ARE MAKING COPIES �2 j,,,1
<br /> PERMIT NO.
<br /> PUBLIC WORKS
<br /> EVERETf,WASHINGTON 1 1 3 � Z BLDG. DEPT. NO. �
<br /> ❑ OWNER �AGENT DATE
<br /> ------_ / t'/' :,i �r � . � . - u . ,
<br /> � , ,;�
<br /> APPLICANT/FIRM REPRESENTED --__ - _
<br /> ADDRESS � ^ �l � ",��� �L� CITY 1- ✓F' .R r f.�ELEPHONE
<br /> � - — .�, . y��a ,,���i'c I�� c� �- r ��
<br /> HEREBY APPLIES FOR PERMISSION TO .'%-' r` -
<br /> �AR/CC�,A. Fc•c �i7-SSEniC�.c /��vLcA-Din.(
<br /> ATTHE FOLLOWING LOCATION � n � �• �� L°i ��'`! �:'�l�r"�T n�'".rrs�� n+�r�-�t S��
<br /> Attach five(5)copies of preiiminary plans for proposed work Oraw to scale�nd show the following as applicable:
<br /> ' Property li�es and street identity. ` Topographic changes requiring cuts and fills '
<br /> • Outline and dimensions of existing and other than normal foundation.
<br /> proposed structures. ' On-site drainage systems when required.
<br /> ' Existing and proposed utilities. • F_rosion con rol m�tflods when required. �
<br /> ' Centerline of abutting right oi way. • North arro���-'_ � :-
<br /> �<<ti' � Z G � ,� 7-�':
<br /> Signalure of Ap ficent / �
<br /> coNoinoNs: PUBLIC WORKS PERMIT ' �
<br /> ' .:� .�. C�ac_l,. �ctic� s� ��� � � � o � o � ��� �}-���„t '_j_:_
<br /> , -;- i a; }� I y , �,� � N�5�, i + ;
<br /> I `,�` � � � -
<br /> ��. _
<br /> � .�� .i: ;_ , : __; __�;�`_ ,�.:� f
<br /> ' � �� . � � ` � _:_ . . 1 _._�.._ .�... r �� i ' _' .t i J�� ! # 4 j � _ �
<br /> i , ,
<br /> , _ -
<br /> : '��`i, � � i � , � � '-�. 1�_� .�I.�� � � ��� ��_. _1_1 .. � � � � �.1-t a_. . �
<br /> �-�-, -,-�
<br /> f _� 11� -� � _
<br /> ; iZ � �-� , G i , � 1t
<br /> ��,. . . 1 . � I � �.�a � . L S . � i' I -�_ J. �.�. { I �
<br /> � � � � �_ 1 � � 1 1
<br /> -��_� ' _ __ � � � � ; , t ,� . � � : L. r �.._� � _I. r 1 . .
<br /> a_., 1 I } - ,.
<br /> � ��f... _ ,� . , 1 ._.{ ' � � ' �� �r � �� �� 1
<br /> , � _
<br /> j � � 1_ia � � a , � . , `� � � � �� _j , �.. � '__ '
<br /> i �1�- ' �t� - � _!-� i. �" � 9-� r7 � � +- �
<br /> � , :��� � a � � � - � a r'�t � � _ t- :�:_ f ; � 1 � j
<br /> � � �--� � � -r � � � r 1� , � I �_ 1a � �
<br /> I +t .!_ ���}' 7� }'��i ' j � f � � - - �- - � '
<br /> � � _ _ .
<br /> _ _ . _ ..
<br /> . _ � �_� ��� � � �j .�_t a. ��} i ..�,. f-.T � � � � . . ,
<br /> �
<br /> - �.� � .���� .
<br /> . _
<br /> � � � r-t ,� ,� t- � 7 � �
<br /> � , , •
<br />� � 1 ' �4r1 i .�.-�fi�� i..1_ � 1 a
<br />' , � f . „- -+ � . ,L,..�-. . The undersignetl owner hefeby agrees b hold an0 swe hermlesM1
<br /> I , � � t,t��1 � ,J,,._ � r . �j�f_I- �i ��—�--... the City ol Everell trom any ana au cieime lor damepe�, cosl�,
<br /> ' ' , . ,. ... ��.. . _. � � ... ! ..: e•Denses,or wuses ol ecllon thel mey arise beuuse d in�t�ll�lbn
<br /> . . � � � enE maintanance o� the Improvament or other riphtwf-w�y u�s
<br /> herelo epP�letl tor entl luriher epreee to femove��me upon nolke
<br /> Irom Ihe�ity an0 to re0�ace pubNc property d�mepsA thereby.
<br /> �, ��� /i/
<br />, ,--�A ED FO CONSTRUCTION DATE A�N(��DGEMEN OF CON�TIONS C /L�� , �
<br /> N(1
<br /> � , z � Z-- l ! �� C-'l (1r� o y
<br /> APPROVEO AS CONS R CTED D TE � SIGNA UR OFAP LICANT DATE � '
<br /> PERMIT IS VAL FO 1 YEAR paST ON CALL FO 'INSPECTI�DN
<br /> 259-8811
<br /> - EXPIRATION JOBSITE 24 HRS. BEFORECONSTRUCTION
<br />
|