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0 <br />% e"w I APPLICATION FOR PUBLIC WORKS PERMIT � <br />c g' �'g <br />�; Type or print cleady with ink <br />PRESS HARD - YOU ARE MAKING COPIES � � <br />� PERMIT NO. � " <br />PURLIC WORKS <br />' EVERETf, WASHINGTON / BLDG. DEPT. NO. �� �`� �� _ <br />' O OWNER ISAGENT DATE � Z��_� /_ <br />I APPLICANT/FIRM AEPRESENTED �• . Si°�'N��2 �r✓ST. __ _ <br />AD�RESS ! U � �� % � ST CITY � TF_LEPHONE ` �Z"S�O � <br />HEREBY APPLIES FOR PERMISSION TO �e� ��'�� ��� ��'� K <br />l/����'� �—/,4 /�,J f�C`-/1 �'�Li --- <br />ATTHE FOLLOWING LOCATION <br />� �� <br />6 � ._L�vr�CGi <br />� r E� <br />Attach five (5) copies ot Freliminary plans for proposed work. Draw to scala and show the following as appticable: <br />* Property lines and street identity. <br />* Outline and dimensions ot existing and <br />proposed structures. <br />" Existing and proposed utilities. <br />* Centerline of abutting right of way. <br />* Topographic changes requiring cuts and fills <br />other than normai foundation. <br />' On-site drainage systems when required. <br />* Erosion control methods when required. <br />* North arrow <br />C' ��5�� ���,./ <br />�LIC WORlCS P!ERh1lT <br />CONDITIONS: <br />��.... � r . <br />� . . . . �f 7'_ ; -c ,�,J � %'�/� ,% r!�/"�J <br />�..... ,, / <br />h.... ._ .... .. _.... <br />.. . , ,..... <br />.♦: l.: �,. + .. �. <br />�.�__ _�___ . . . . . . .._ . .__. _.. <br />i_T._ _._-__.._ . <br />. . . . . _ . � . . . . <br />.. . � ..,- ... . <br />. �.� 1.... � : , : , . . A::�. . . . . ..: � . . . . . . . . . . . . . . . . . . , . . . . i . . , . . . <br />. ...�_ -._..- .__:._ .. _.._.. . � J_.. . .... . . . ... . . .. .. . . .. .. . . _.. . . . ... ... . . . ... <br />� . . � � . . . .... . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . r . . . . . . <br />r . { . . � . . � . . . . . . . . . . . � . . . . . . . . . . . . . . . . . ... . . . . <br />i. • I .... . . .'� . . . . .. . . . . . . . . . . . . . . . . . . . . . . . � . �, <br />e � <br />i I <br />.--_..._.�_.._._...�_....�—�-.._:..-.�...__f ..___.__`-� _�...�___ .. .. .... . . . .. . _ . . . ... . . ... ._- � -_-• <br />i . f.. . �' . . F: : . . . . . . . . . . _. .. .._ .. .. .....-_. . . .. <br />� • � . � 1 . . . . .� . . . . . . . . . . <br />. . . � . . . . . . . . . <br />. � . . � . � . . . . <br />_ .�..._.�... .... _. . _ . . . . . . . . . . . . . . . . . . <br />r---�_, t_.. -- –4- ------ <br />.., .�.. ;.. ,..., <br />...,:.,�: .:;...;. <br />--- ,. ,. ;._ ._ <br />_ �_ _.._ -__._, _ _ <br />. � � , � ,,;, .. 7he undersi9ned owner hereby agrees to hold and save harmless <br />.... : �.. : . . . . : . . . . . . . . . . . . the Ciry of Everelt imm any ana au claims lor damages, costs, <br />. _ . :.:;�_ �; _:..:.. � . . . , , . . . . . !.. _ . . , expenses, or causes ol ac�ion thal may arise because o� inslellation <br />l-_. -__.._.._.... i.. -..._... ...:..___.. . and mainlenance of the improvemeM or other riqh4ol-way use <br />� � � � � � � � � � - � - � herelo applietl tor and further a9rees �o remove samr. upon notice <br />�� �� � ' � ' Irom Uie City and to replace public pmpo�y damagetl thereby. <br />. j /, ._y,; ' <br />� i, <br />/'..i'�s`?�+• .: ��/'�✓��-`_ �7.� : . ' Ci- <br />PERMIT IS VALiD FOFi 1 YEAR <br />EXPiRATION— �� �' �`���' � – <br />ACKI:OWLEOGEMENT OF CONDITION� <br />.' (. . . , , , �. . , . <br />SIGNATUREOFAPPLICANT DATE <br />POST OP6 � ��Ll_ FOR INSPECTION <br />259•881 i <br />JOB5ITE 24 HRS. BEFORECONSTRUGTION <br />