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r <br /> � - . __. . _._.__ ..__...v-- <br /> r <br /> �"'"�" APPLICATION FOR PUBLIC WORKS PERMIT <br /> TYPe or print cleerlY wlth ink <br /> PRESS HARD-YOU ARE MAKING COPIES <br /> PUBLIC WORKS PERMIT NO. $3 �7 <br /> EVERETT,WASHINGTON BLDG. DEPT. NO. <br /> �OWNER ❑ AGENT DATE <br /> APPLICANT/FIRM REPRF_SENTED _ .� 1 <br /> ADDRESS Q(�� � ^ � I"� c.L(�P � S rF . C�Ty � ���Y/, TELEPHONE_� �7 GX�S� <br /> HEREBY APPLIES FOR PERMISSION TO �)7 S f a I� f�l 1 U P �cJ !� Lw l � <br /> ATTHE FOLLOWING LOC.4TION O � � � /-c�� ��--,—� < <br /> / am F/�, �d �; ���� z, � �. <br /> Attach five(5)copies of preliminar; ;,:ar,s�or proposed work 6raw to scale an show the following as aF � le: <br /> " Property lines and slreet identity. •Topographic changes requiring cuts and fills <br /> • Outline and dimen�ians of existing and other than normal foundation. <br /> proposed structures. * On-site drainage systems when required. <br /> ' Existing and proposed utilities. * Erosion control methods when required. <br /> •Centerline of abuY.ing right of way. ' North arrow <br /> �Y.��/� L���ol � 1'�X�T�t�n <br /> _ �_ �' Slpnature�ppiicant <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> _ . . . . . . . ._ ._ ._. . . <br /> � _ __ . . __. _ . <br /> � . . . . . . . . . . <br /> 4 . /. '"T�iaf D.or�%d� .ot 7/ e �lri✓<<.,�a . w.�-�i�n �-Ire �,�.ht-o�- wa <br /> _ . � �/ r <br /> : : ; /'.iNs l- b e : �ia;u td: � � : . <br /> . . . , <br /> �__�_ . __ ; <br /> � . � ._ _ � - _. . . f . . ; : � __ { _ . . <br /> j ' . : . : � <br /> , � , . : : , . . . : � . . . . , . . . . . : . <br /> - _._ 1 . ._ , . ._. _ __ . _ . __ . _ . . :_ . . _ . . . . . . . <br /> : . . . ; : . � � ; � <br /> � , . <br /> . : . . . i . . . . . , . . . <br /> i . . . 1 ; . . � . . . . . . . , . . , � . . <br /> __ __ �T_ _ __ _ � � ��_ . , . . <br /> . . . : --�. . . : . . --r- . . f--. . . - .: - :- -_ ; -- --� . . . <br /> : � : ; : : � ; : : f � : : : : i : : ; . : � ? : : : : : � : ' . . ! . . : : ' . . <br /> - -�- � _. _ __ _ , _. .--. _ _ . : <br /> . . . ,---�- -f-' . . . . . . . . ( . . <br /> , � , <br /> . . . _ . . . . . . . . : . . . . , . . <br /> ; . . , . . ; . . . . . : . . . . . . . . <br /> �. _ ., - . . �_t'.^.._' __ . '- T.... .. . . . . . . . . . . . . . . <br /> � � � • r • � - � • � � • � � • � l � � � . . . . . 7he untlersignetl owner hereby agrees to hold antl aeve harmless <br /> : • ; ; : : : t ; _ ; ; � � � . � � • � � � � � . . the Ciry of Everett tmm any ana au claims lor damaye& coats, <br /> { . ezpenses,or causes ol ectlon that may atlaB becauee Oi Inete118Hon <br /> � -� � � � ' �� ' ' � � � - � ' - ' ' `- `�— ' ' - � � � � � and meinlenance of the improvement Or othar rlphhoFway uee <br /> � � � � � � � � ' � � - ' � � - � � � hereto eOGlletl lor and further egrees to remove same upon notice <br /> � � � � � - - Irom the City and b replace pu6ilc property dameped thareby. <br /> � 3-i��3 <br /> OV�NSTRUCTION DAT ACKNOWLEDGEMENTOFCONDITIONS <br /> � Z5 �3 � '� <br /> APPROVEDASCON UCTED DATE S NATUR FA,��ANT� �`� ~� <br /> d"� DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> F��ST ON 259-8811 <br /> EXPIRATION. JOBSITE 24HRS. BEFORECONSTRUCTION <br /> J <br /> � <br />