|
_ �
<br /> everett APPL.ICATION FOR PUBLIC WORKS PERMIT
<br /> � TYPe or Print clearly witn ink ;.
<br /> PHESS HARU•YOU ARE MAKING GOPIES pERM1T NO. ��'^� ����
<br /> �-
<br /> PUBLIC WORKS •
<br /> EVERETT,WASHINGTON BLDG. DEPT. NO.
<br /> OOWNER t�AGENT DATE _��2O��L-
<br /> APPLICANT/FIRM REPRESENTED CrNVI_�.�JfV-Mv5_�f LG�_--.—__—_
<br /> ADDRESS �L�-�����'��,'^.T��-^c"�Gp�,� ' .� ITY �" TELEPHONE
<br /> HEREBY APPLIES FOR PERMISSION TO .SJ������w'�'�
<br /> �-5 r.�C��(`�O�"20_F'E��QC�._��2T!-�WdZl�
<br /> ATTHEFOLLOWINGLOCATION ��K �d-��
<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 dimensions of existing and other than normal foundation.
<br /> proposed structures. ` On-site drainage systems when required.
<br /> • Existing and p oposed utilities. " Erosion control methods when required.
<br /> " Centerline of abutting right oi way. " North arrow
<br /> Myy� � '
<br /> //�/ /Ps.[.t�1-�S.tG
<br /> " • Signa�ure o/Applicanl
<br /> coNoiTioNs: PUBLIC WORK PERMIT
<br /> /� ��p L:=cJ'(f/rY7���� T T/i%�i /�7f�y �'.�CSf= .C�/�/y%iG� ic�. ..
<br /> / i _
<br /> �/TJ/ �'/9//c.Q �S�,Ti�'�=c�� ;.5 ?� ,��r c.in�<.����'J�� ,
<br /> o.� c�.n-.�-� T�p o N �", � ,S%.�'c� .--�5�. ��%f�
<br /> . �7�i77%'i�t-r �%rJ/t C_ ,_�= /f C��'/?'.'�C.!7 �"y' %'�'�'LtC/'��7: .
<br /> /
<br /> -�) ���icF,'�/1)�C'c'/E/�'v.t!'��7�� /�.E'c>�h�c.c.`"iy�S`, �f'c`SGr��� Ti'/1JC+ .. � . .
<br /> .. F_.r,.'-✓J`J /�S � O i� /�� (n. G.t), c��/�c- �d'G ��G�.{',�'C C iGr�,G�
<br /> r �
<br /> ys ��,.c'�"�' T'� �y c-,Ty ��.�.r��=� ��;,�;o _
<br /> .z'/ c�v�'n-i,I/�' r�= /��'i/C�i':;cv' c.�iTi;" `�'/�^� -S�is?fi�il,!'� -,-
<br /> , : . > . .. ' , ., , : ._ _:
<br /> � , _ � w � �.... M..
<br /> r- f- _� .
<br /> f � 4—� � ; � t ,, � ;. 1 ' � '_V _. . The undersigned owner here�y agrces to hold and save hermless
<br /> f ( � � � _ � , �_f.�J ' _ ( ' -�.-. �he Giry ol Everelt Irom eny ena au claims lor deme0e5, costs.
<br /> _.
<br /> , ._..,..._, , :_i � !.� .,_..�, .. ,. . -. . -. -�'-� -'-� eapenses,or causes of nction ihat may arise beceuse of Inelellelion
<br /> .. . . . . .� , and mainlonence ol t�e improvement or olher righl•of�wey use
<br /> - �� � � � �� �� - . herelo epplied Icr and luriher egrees to remova semo upon notice
<br /> Irom Ihe City and �o replace public property damepeC thereby.
<br /> �_ �.." ,. _ .. ./.
<br /> .. _ _.��' . _ .,7!/ �l
<br /> � �. 7
<br /> A O ED �CONST UCTION� � DATE '� ACKNOWLEDGEMENT OF CONDITIONS
<br /> J �
<br /> /���� ,-� �� � , 'Ll ..;, ,,`�'�,� �7,z�-��?
<br /> APPROVED AS CONSTR T ATE � � -31GNA UR �A P�'R� LICANT �DATE
<br /> PERMIT IS VALID FOR 1 ' CALL FOR INSPECTION
<br /> <<<�?7`�� POST ON 25J•8811
<br /> EXPIRATION �/ "��� JOBSITE 24HRS. BEFORECONSTRUCTION
<br /> „�,..
<br />
|