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everett pppLlC�#TION FOR PU@I_IC WOFiICS I�EREV9IT <br />� TYPa or print cleud,v wilh Ink <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. �� `� � <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. NO. <br />❑ OWNER ❑ AGENT DATE "� " � "� 1 <br />APPLICANT/FIRM REPRESEIJTED %"�E'i2rZc•ti� ����i�i�/5�=<�� <br />ADDRESS � '" `1 1-~'p �\��- iJr- CITY �SFJ ' �ti�-'�= TELEPHONE �-+ ��+ -� Z"� <br />HEFEBYAPPLIESFORPERMISSIONTO ���� �Lz�= }����'� ��� ` '��'� �� �'t�`'�"`_�'`- <br />CA \�A�s�l� l�2i_s"��zv t�5�"n A< S�i= S»'2vx= CA< 5 rR>'ric�.�✓ <br />ATTHE FOLLOWING LOCATION �� � �-�'��2G2t�1=a1 6��A�y <br />Attzch five (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 of existing and other than normal foundation. <br />proposed s4ructures. ' On-site drainage systems when required. <br />* Existin� and proposed utilities. * Erosion ontroi methods when required. <br />* Centerline of abutting right of way. " North a w <br />. � ...�� <br />• Signature ot APPlmant <br />�UBLIC WORKS PERMIT <br />CONDITIONS: _,G.. % <br />�Gc?J4�Z �,�..f�("if� � � Gc*z.:: �u-C'i/.d �= <br />� . �/-. Z7-8 Z: ,S/� ! � % ' � / � <br />', ���zu�: � 75. �' � �l"� 3� u�`�"� za-� <br />; �.. <br />/�'"z°P <br />�. _��� . � . <br />; ' . .._.._.__._ ... . - <br />;:::::. ... ,... <br />; : , , ; . . , : : <br />t__�_.�� _, __ ._ __ __, _ ,. . . . . . . _, — - _ <br />i.,. � . 1..:; .. �. ,.. <br />. �.. 1...� .. .i. . <br />;..,._..�._.; .. .. �.. . . ' <br />- - � .��__� _ . _ i -� -- - ~— <br />� .. ,I�. .� _. . .... <br />r , ; � <br />�---• - -- . L�__.:� ^; - - :--- ; <br />�- �:"::j:::i;: ;: ;i:. <br />;..... i ... ...:...:.._ <br />��_�_�T---}----'.--��--+�--r--' ' The undersi9ned owner hereUy a�rees to hold and save harmless <br />i��� i� � , Ihe City of Everetl twm any ana all clalms br damagos, co&�s, <br />' � � � � � � � , . , . , . , . . erpenses, or causes ol action Ihat may atlse bocause of inslallation <br />� �- � � . . . . _ . -.�-. .. and maintenanca ol �he improvement nr other riflh4ol�way uso <br />� � �. . . . . . . . . . . . . . hereto opplietl lor and lurther egrees to remo�e samo u0on nolico <br />._. . . . . irom the City and to replace public pmpeAy dama9ed Iheroby. <br />- _ '/ %�� �� � -�_�. <br />PERf�IIT IS VALID <br />EXPi Rp:T10N <br />YEAR <br />AC �OWLEDGEMENTOFCONDITIONS <br />/L� . (�,- � ...�--..�� �^. � -� 1. <br />SIGNATUREOFAPPLICANT DATE <br />CALL FOR IhISPECTION <br />POSi ON 259-a811 <br />, JO�SITE 24HRS.BEFORECONSTRUCTIOPd <br />