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� <br /> r <br /> , 'l <br /> � <br /> _----------- <br /> ��p APPLICATION FOR PUBLIC WpRKS PERMIT <br /> PRESS HARD��y rint clearly Wi�h��k � <br /> � PUBLIC WURKS OU ARE MAKING COPIES Q <br /> EVERETT,WASHINGTON PERMIT NO. U� � <br /> ❑ OWNER ❑AGENT DATE �� �=�j� <br /> BLDG. DEPT. NO.�_ <br /> AFPLICANT/fIP.M REPRESENTED OS�.L� �� . <br /> � � <br /> ADDRESS � 3 0 1 ��'� <br /> ---_—��J L-tv rJ �J e u i e <br /> HEREBY APpLIES FOR PERMISSION TO ��- � i �h CITM C�l�TELEPHONE 75`>--!J <br /> J� <br /> `� �v � iv -t�r .. /J � '`� � �a /� � �1 G L:. <br /> < <-s� .�„ l�r- �e.�r D�L. <br /> ATTIIE FOLLOWING LOCATION _ 2?,C'j � <br /> � �u e��` <br /> Attach five(5)copies of prelimina � ,� <br /> ry plans for proposed work Draw to scale and show the following as applicable: <br /> ` Property lines and street identity. . <br /> ' Outline and dimensions of existing and TOpographic changes requiring cuts and fills <br /> proposed structures. other than normal foundation. <br /> ' Existing and proposed utilities. ` On•site drainage systems when required. <br /> ' Centerline of abutting right of way. * Erosion control methods when required. <br /> North arrow <br /> ������� ��� ���� <br /> PUBLIC WORKS PERMITeu �APplicenf <br /> CONDITION.S: _ <br /> � . .__ _ . . .___ . _ . _ . . _ _ <br /> � � � . . . , - <br /> � . . � (�aru5e ; .acees:. :.,,�sF 6c � . : : <br /> .., 4//'y . <br /> � / <br /> I Z. . �i.�e� ee/�t.-...,�C . . n <br /> ---' ., , i . �o.�,. rt H•2r�✓ C,a( /Ytoi-� .. . . . . . , <br /> '-:-..__ . . �, .�:%/�IH / / . � nS s�n,...� � - - <br /> . . i . ; , �� ' ' � �a1�f!�N. . iJ. . N✓!�y<� �i'a�,oS�.V, ac�c��ior . . . <br /> �++ : . I ♦ . . . . . � � : ' . . . . . . . . . . . . . . . . . . . . . , . <br /> T' 7 *-^ . . . . . . . . . <br /> • . . . � � , � . . . . . . . . . . . . . . . . . .. <br /> - �. . , I � , . . � . . . . , J� , ., . � _�_ ' _� : i . . ; ' • . J� . . . <br /> r -.� . . ., . � . . 1 . . . •�1. '�__�'-^ � . . . ' ' . . .y "1-��..-. . . , ! "" . . . <br /> _��:__�_� I ' ' . � . . � . . . � . . . � . . � ' . . <br /> _ , , .-� . - f- _���� _. . : , . � : : : � . . � : i�: : : . <br /> : ; , , j - <br /> : . �: 1 : : ; . . : � : . . ' : : ( . : 4 , . . , . _. : <br /> — -.�.�_�� � ! . . . i . <br /> __�_�_._._,_._ � <br /> i � � � � • , ! . . . �� ; � ; 1 : ' ' � � The undersig�ed owner hereby agrees to hold end�ave harmless <br /> � _ . . . . , , . � the Clty ol Everett Irom eny ana aii clalma for dame0e4 coate, <br /> expenses,or ceuses of ection that may arisa becauae of inetalletion <br /> ,' , � � � . . � � -� antl malntenence ol Ihe impmvement or olher Nphbof•way uae <br /> . , . . . . . . � <br /> hereto applied lor end lurtha�aprees to remova aame upon notice <br /> — �--���� � � � , . . . . �wm the Ciry end fo replace public property dameped tAereby. <br /> ! / )t o� <br /> Rfre�iuvEO fOR C NSTRUCiION <br /> DATE AC OWLEDGEMENT OF CONDIiIONS <br /> �' OVED AS CO�p ' D E3 "�- �4 <br /> � ��< - -= i/a�/s.3 <br /> � PERMIT IS VALID FOR 1 YEAR SIGNATUREOFqpp �qry, <br /> DATE � <br /> POST ON CALL FOR INSPE�TION <br /> EXPIRATION JOBSITE 259-8811 <br /> 24 HRS. BEFORE CONSTRUCTION <br /> � <br /> � � <br />