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'��:§4�::':'.' _ <br />,-;• , <br />', � pppLICATION FOR PUBLIC WORKS PERMI <br />T <br />0 TYPe or Print deadY with ink <br />PPESS HARD • YOU ARE MAKING COPIES pERM1T NO. �-�'n <br />PUBUC WORKS � BLOG. DEPT. NO. <br />EVERETf, WASHINGTON <br />❑ OWNER �,AGENT DATE w <br />APPLICANT/FIRM PEPRESENTED �h I �� � !Y u � <br />� ,. 'i J C17Y r �a TELEPHONE ��.��SSY <br />ADDRESS �� a S � "` � <br />HEREBY APPUES FOR PERMISSION TO a�� y �� ni [ �' �'e `` �- <br />AT THE FOLIOWING LOCATION � <br />� Attach five (5) copi,� �f preliminary plans for proposed work Draw to scale and show the following as aPPlicable: . <br />' Propeity lines and street identity. <br />• Outlin�� and dime�sions of existing and <br />proposed structures. <br />" ExisUng and proposed utilities. <br />• Cer.terline of abutting right of way. <br />c,��1br ���{. � ���Buc <br />ONDIT�ONS: � <br />r <br />.:;._� "�_ <br />; I <br />_. . <br />�L�� � <br />� <br />_� ,' ' . : <br />-::::.�: <br />7'�r i+� <br />�usc <br />" Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On•site drainage systems when required. <br />' Erosion control methods when required. <br />* North arrow <br />� " '- �/GS' <br />1 i l. . _�-,_ �, , �_,> k <br />; , _.:...� �: , <br />. i � - . . . . .' � . . t. ; <br />.,: �...;.,.� :: <br />. _ _ 1 � ��._--� -_.._.L : t _ - <br />:_ ;_:.! .# ! : <br />-,�N . ,f..�.. �. <br />�::1.�:�~'.��� <br />tl. , r.�� � _;.. <br />y_... . ••- . <br />��i <br />::}��' � � <br />�.. _ .- __ i.. . . . <br />. . . . . � . y'. . . � <br />PERMIT IS <br />EXPIRATION— <br />� <br />The un0ersignetl owner hereby ngreee to hold antl 6eve �ermlees <br />Iha City ol Everett trom any ana ell clelma for CerteQee, coete, <br />ecpensee, or causea of acllon Ihel mey erise bec�uee n� �oeblYtion <br />end meintenance ol the Improvement or other rl9hlroi-w�y uae <br />hercto e0olletl br end lurther epreea lo removo aame upon notice <br />imm Ihe Glty end lo replece public O�a7Brty Eemaped Iheroby. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />E� p -pp� ' v �'SIGNATUREOFAPPLICANT DATE �, <br />FOR 1 YEAR CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />- <br />__ <br />-- _ <br />- ----- - - __1 <br />� <br />