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_ -- --� <br /> __. ----_ _ . <br /> __ __ _ _ -.� <br /> _� . - ---- ---- ---- - , <br /> 3 � `"°`"` APPLICATION FOR PUBLIf� WORKS PERMIT <br /> � TYPe or Print clearly with !nk <br /> PRESS HARD -YOU ARE MAKING COPIES pERM1T NO. �z� <br /> PUBUC WORKS ��; � �; � �, <br /> EVERETT,WASHINGTON � � „ , �,g � BLDG. DEPT. NO. � '' � <br /> �OWNER ❑ AGENT DATE _ � <br /> APPLICANT/FIRM REPRESENTED -Tr �d W�^`-1__ C oN S �I �^v c� � (7 N __ <br /> V <br /> ADDRESS �R �� -3 � S+�V�'. S � �- ' CITY rv< � TELEPHONE S 5) � ��1Z� U <br /> HEREBY APPLIES FOR PERMISSION TO TN SI A I I 1 � ' C�-�-IA-� � �'�T-�` <br /> � " IV� wcti <br /> ATTHE FOLLOWING LOCATION _ �v �rJ �L U �I � � D I� • <br /> Attach five(5)copies of preliminary ptans for proposed work.Draw to scale and show thP following as applicable: <br /> * Property lines and street identity. * Topographic changes requiring cuts and filis <br /> * Outline a�d dimensions of existing and other than normal foundation. <br /> proposed structures. * On-site drainage sy5tems when required. <br /> • E�?�t�ng and proposed utilities. * Erosion control !netl�ods when required. <br /> * Centerline oi abutting right of way. * North arrow <br /> Q � C� <br /> SignaNre o�Applicant,� <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS; _ _ <br /> '� . . . . '� u��'•l,�'Y /JO�� �.::.. . Oi�_ . "� �^ ` �f� vf' ��..a . (��.� -Fin �., . � �`.c. . . . . , . <br /> I . �. . . '. . �. � .I i �01 �� I �1 Q�'l� �O � . � �.'J N �„ . Lnn Nt S �� �7.`C. ��!il '✓ ,L. CI +; . . . . . <br /> I I <br /> . t �.....-... 1 . . .-._ . . . ._. . . . . . . . . . . . . . . . . . . . . . . . . . _. . . . . . <br /> 1 ... � �. . - . . . . . . . . � i : . , . . . . <br /> � <br /> i ' ' ' � � !� ' � <br /> � . ._. . . 'S i n n�.�- . . . o <br /> - � , � • , __ � � u.�P� ,�G .� - � <br /> i : ; : , . ; : � . : '. . . <br /> , <br /> � , <br /> � . . . , <br /> , . . . . . . . . . . _ . . . . . <br /> � ___... -- - ____ . _ _ <br /> - -- .- � � <br /> � , _ . : : � : : . . : . ' . . .: : ; : <br /> I � , � � <br /> . <br /> . � . , <br /> � , ; <br /> __ _ . _ _� . .__ ,--- _ . <br /> ._ <br /> i , <br /> . � . . . � . . <br /> � , ; • : _ <br /> � -- : : � ' : , . <br /> , . , , <br /> �-- <br /> �` 1"��"'�- ! . . 7he untlersigned owner hereby agrees to hold and aeve hermless <br /> � ��'. � - . I �. �` - - the City ol Everelt from any an0 all cleims for d0m0pe0. C06t6, <br /> � eapenses,or causes of xction ihat mey arise because ol inetallalion <br /> and maintenance of ihe improvemenl or o�her rlphMaf•way uee <br /> . I . : . . . . . . . . . . . hereto applled for and further egrees to remove same upon rotice <br /> C irom Ihe City and to replace public praperty demaged t�oreby. <br /> f i <br /> I. . ,.-,. ,r .f:. ,� . . <br /> .,.r-�j.;' , i' 3 - 17 - �i i.. _ <br /> � <br /> / ��i��,',':> � a�•�'.'_ <br /> ,. PRO' R TRUCTION D TE � ACKNOWLEDGEMENT Of CONDITIONS <br /> _ .s � � z-- �^� !p ` r <br /> .i. � , � <br /> APPROVED AS CONSTRUCTED DAi , SI A RE OF APPLIC NT ` DA <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTIOlV <br /> POST ON 259-$811 <br /> EXPIRATION 3 � � � � k 3 JOBSITE 24HRS. 3EFORECONSTRUCTION p <br /> _� <br /> .;;n,. <br /> \ <br />