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<br />� � APPLICATION FOR PUBLIC WORKS PERMIT
<br /> Type or print clearly with ink �(
<br />( PRESS HARD-YOU AFE MAKING COPIES pERM1T NO. O � �
<br />� PUBLIC WORKS BLDG. DEPT. NO. a �
<br /> EVERETT,WASHINGTON
<br /> ' CY6�GINER ❑ AGENT DATE .f�'-��`�'�z ,
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<br /> I-�' /p.wifS ` l�L/r5(/�1�_.-----
<br /> APPUCANT/FIRM REPRESENTED �L_./If-�- --��-- — -
<br /> AODFESS 'y�3Z ��'a� F`D'efsj �� ��T� �v6�FTT TELEPHONE ��l"'��
<br /> HEREBY APPLIES FOR PERMISSION TO G-cNST�-u 7 -�,+'�/;�c�
<br /> Z /�/r Fa'«'Tr_ .�C�/,
<br /> AT THE FOLLOWING LOCATION '�1� �
<br /> Attach five(5)copies uf 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 of existing and . other than normal foundation.
<br /> proposed structures. • On-site drainage systems when required.
<br /> ' Existing and proposed utilities. • Erosion control methods wh n required.
<br /> 'Centerline of abutting right of way. ' North arrow� , ^�G�
<br /> �
<br /> /Signat reot OP���aN
<br /> coNoirioNs: PUBLIC WORKS PERMIT
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<br /> � , �. � � � � � ' '. The un0ersignetl owver hereby agrees to�old an0 n�ve Mrmisu
<br /> � � . . the City ol Evarett t/om any entl au Cleims for damepe�. cw��•
<br /> � � e ' � " ' . '. expenses,or causas o�action that may eriae beC�uee d iMtNl�tba
<br /> ��� �� �� � ���� � � ' � anE mainlenence o1 Ne improveme�t or Other ri0��'a'w�y uM
<br /> , � . � �ereto ap0��ed 1or end lurt�er agraea ro romme eams Wo�^o� ;
<br /> , // irom t�e City and to reD�ace pu�lic propeM 4��^s7� ���dY�
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<br /> ACKNOWL NT O IT .-�
<br /> App�D FOR cONSTRUCTION DAT � .
<br /> �� 3 I�I NATU E OF AP CANT DATE
<br /> APPROVED AS CONS U TED DA E CpLL FOR INSPECTION
<br /> PERMIT IS YALID FOR 1 YEAR ppST ON 259•8811
<br /> JOBSI�E 24 HRS.BEFORE CUNSTRU�TIAN
<br /> EXPI RATION
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