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_ � 1 <br /> 1 <br /> 1 <br /> ""'�" APPLICATION FOR PUBLIC WORKS PERMIT <br /> e � TYPB or Vrinl claBrlY wit�Ink <br /> PRESS HARD•YOU ARE MAKING COPIES pERMIT NO. g`� 3� <br /> PURLIC WORKS <br /> EVERETf,WASHINGTON BLDG. DEPT. NO. <br /> , �'OWNER ❑ AGENT DATE _�'��Q �Z _ "'� <br /> APPLICANT/FIRM REPRESENTEO ���k. Cct I �v� ti _� 3'i'`�//� <br /> ADDRESS jJ�' M�w�56y �G"e CITY F�'�� TELEPHONE� <br /> HEREBY APPLIES FOR PERMISSION 70 .��4_�-a�� ��w C.F�. a.,J' oa�e sl,o.���er a�en._ <br /> G.CroSs �v.�a�c io_ t�rn�er�'v <br /> AT THt FOLLOWING LOCATION y��_ a�� <br /> Attach 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 dfinensions ot existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> • Existing and propcsed utilities. • Erosion control methods when required. <br /> "Centerline of abutting right of wzy. ' North arrow <br /> Signa�ure ol Applicanl ' <br /> coNoiTioNs: PUBLIC WORKS PERMIT <br /> : _ , , <br />� . � �� � . l li�1� n..�cy� .���,.'>d n �� � ` � "`�j ' ��^I –�- ., { , <br /> (� w.�S� c rn... c J 1 1 io....p. `1 L. . <br /> -I !--( � � . Ct..a?/ , CIy.0 Sc .,�i�n ;F�G. ci.S Sl��.w v. 4� .�. � .I_ 1 .. <br /> ; , �'-f' �.v�-F��? P�a" � ���C� � Z���� � - : � <br /> _ '" a� <br /> r' t`�R�UL ����r.�C-1�1 — SL�� - f�I�Z ; i ; <br /> � .:_� � <br /> y,� ��f�� //1 �j� <�1�...�--. . �I � a <br /> �J/,� _' , !� ��\ ��� \��,•1 W'1 ��'.-1L1�+�(,(. �� �o ' ' j <br /> I �... � I / � . . �, <br /> i � '—�t� � �� �k� �I�x�.�v � <x���..�� , 1 `:_�_ <br /> � 1 ' �� '. �-, <br /> I+`�, � t-� �-� <br /> ,�.}�, }+.. , , t ��--�, � ; -}-{-{--� f .�-l� r ; .. . . . . . : . ., .: . .. �. : <br /> � <br /> � i ���.. ;_i.i � L. . <br /> ! .� ;,rt a�' 1 �� I f �-1 1 � � J - I T�e undersigned awner nere0y nBrees to hold and aave�ermlase <br /> � ,� { _� , . �. ,� I _ . :.. 1 _ �._,- I � � :. , t�e CIIy oi Everett �rom any ena au culms for Gmaqe0. co�t4 <br /> �� .,. . ... . . .. � -i- ' . erpensaA or ceuaes ol action thel mey adse Dec�use ol In�l�lltllon <br /> -�. � . . � . - � •-� —,--1 � � enE meintenence of t�e Impmvemont or ot�er tlOhtro4w�y u�s <br /> � � � - � � �� � � � �. � ' � " '� '��� ' �ereto ep0��ed for end lurther e9reee to remove e�ma upon notita <br /> � Irom tha City end b replece OubliC propeM dam�ped theroEy. <br /> ��_. iJ.�•:� 9 rFL_ . <br /> �APPROVEDFORCO TR 10 DATE ACKNOWLEDGEMENTOFCONDITIONS <br /> r—_ <br /> ' �`� G-�-�3 �,.�f, ���1irc.� iZr y/�'- . <br /> APPROVEDASC NSTRUCTED DATE SIGNATUREDFAPPLI NT DA� <br /> °ERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTION <br /> 259•8811 <br /> PIRATION JOBSITE 2qHRS. BEFORECONSTRUCTION <br />