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. <br /> , _ <br /> everett APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Prin�Clearly wi�h ink <br /> PRESS HARD•YOU APE MAKING COPIES pERMIT NO. �� -��� + _ <br /> _ PUBLIC WORKS <br /> EVERETT,WASHINGTON BLDG. DEPT. NO. <br /> � <br /> �LOWNER ❑ AGENT DATE __.I.�__��� <br /> APPUCANT/FIRM REPRESENTED _�O����I!�? �����—_�—_—__._—._—_ — <br /> ADDRESS �'� `���' G� F.�\I�UOO7 I� . CITY1 \I�=��b-�I TELEPHONEI��� S-(�SSO <br /> HEREBY APPLIES FOR PERMISSION TO �r';y-�' ✓ !t/�< �%Y ���_� r�in � r r0� ;"f-� 2.t d <br /> / ' <br /> /� <br /> �',- . ��:i �. -- - n � — <br /> ATTHE FOLLOWING LOCA710N �Sl� ° �'��"r���' �� ��'��-��-�-' `""`�'� <br /> Attach five(5)copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br /> * Property lines �ind street identity. � Topographic changes requiring cuts and filis <br /> ` Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. • On-site draina,r,e systems when required. <br /> ' Existing and proposed utilities. ` Erosien control methods when required. <br /> * Centerline of abutting right of way. ' No h arrow I <br /> �� �1!'l�, ��_��„�u1�� t' <br /> Signolure ol Applicanl <br /> coNoirioNs: PUBLIG W�RKS PERMIT <br /> / � � <br /> `-- ��.5/l�"�"rtC--i�� L� .:i.<<c:�Cv��� _ �2�ii�S aT `rclt �at <br /> _ �'; s" ��p � .3/ y <br /> � ,_ � ,_. <br /> 1 � � : <br /> / ` � � � j " '- <br /> �-: � '_. -�- -1� -> <br /> _; - S� d �Gv�/� �.:ze; C. � rj ST� � C� � <br /> � <br /> , , <br /> — (�f'It��lcr�/ ��,' �� t/ SI`lI � 3C% 7 Cz l� �^.r-xii�?c%n�� <br /> / <br /> � �j ' -�- i_'� i � t:. +--� '_ f r ; i , E r ; � � �._, , i.. { - �;_ . ;-: . <br /> � ` � !a � t + i �_. . _ i �r '-t <br /> ,�i -. { ' � � � ` � j� � t � � _! , 1 � i. � � <br /> � � i L � i ��� ' � � � ' 1 - - I � <br /> , � �, ;� �J Lk� . ,..� -i ; <br /> 1 ;_C�L1 -, , � , T L , � � _._._ . , . <br /> � � � _; � t � ; .a r _; � � ��_; <br /> . � ; � � � .1 � �_; 1 :...+ 1 1 i .� . _ � The undersigned owner hereby agrees to hold anJ save hermless <br /> � ;.i ! � ,�t_f . _�_�.!�. ( ..� � ,_ � .1.-,-_i- . tho Ciry of Evereu imm any ana au ciaims lor damaqes, costs, <br /> : , i i , - ' � __ <br /> � ��-..- � �•- •��- � -� �� � �. � � � ���� eepenees,or ceuses of aclion thet may arise Oeeeuee ol Inalallatlon <br /> end mai.�lenance ol t�e Improvement ar othar riqhhol�way uee <br /> hereto applied lor entl lurther agrees to remove same upon notice <br /> � from ihe (;ity and to replece publlc property demeqed ihereby. <br /> %il� // %�� <br /> PR FOR C N RU ON �DA� A KNOWLEDGEMENT OF CONDITIONS <br /> " li�� �-v�8-8� �,i l. 3 � t�1C�} 1 � -�'�Q-�5�.-, <br /> R D AS O STRUCTED DATE SI NATURE OFAPPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 � <br /> EXPIRATION �� _ �pBSITE 24HRS. BEFORECONSTRUCTION , <br /> / <br /> u+�t .�< <br /> � <br /> I <br />