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y , '� i •'r � -- <br /> everett APPLICATI6N FOR PUBLIC WORKS PERMIT�f�.<<•���� j�-.-� <br /> � TYPe or PriM clearly wilh mk "__�_.. <br /> PRESS HARD - YOU ARE MAKING COPIES � <br /> PUBLIC WORKS PERMIT NO. 'y-� <br /> EVERETT, WASHINGTON � "' <br /> ' , 4��� BLDG. DEPT. N .__ _ <br /> �YOWNER ❑ AGENT DATE �_ __ _ <br /> APPLICANT/FIRM REPRESENTED _ __�• _� ��_• � "" � � <br /> _� f _ _ _ -- --- — -- <br /> � �3 /j <br /> � � <br /> ADDRESS �-_'Y � JL'_ N�F CITY � .1°d�'��1: TELEPHONE-%���' � <br /> --~-- <br /> i �', , �/ <br /> HEREBY APPUES FOR PERMISSION TO _r:��U��p ��� �� ��V C_/__fl �uX <br /> i <br /> -- - - - — .c � � - <br /> -� < i_; �-, r-.; � � c� ���-- <br /> ATTHE FOLLOWING LOCATION �_ I.�—___ _ _ __ __ _ <br /> \ <br /> ! Attach five(5)copies of preliminary plans for proposed work. Draw to scale and�how the following as applicable: <br /> � <br /> j ' Property lines a�d street identity. ' Topographic :hanges requiring cuts and fills <br /> � ' Outline and dimensions of existing and other than normal foundation. <br /> `1 proposed structures. ' On•site drainage systems when required. <br /> �-� ' Existing and F roposed utilities. ' Erosion control methods when required. <br /> "` ' Centerline o( abutting right o( way. ` North arrow <br /> . Sig'na W re ol Applmant <br /> � coNo�TioNs: PUBLIC WORKS PERMIT <br /> _. <br /> u � , <br /> � � � � \� i' � i <br /> _, <br /> f�j� � ,- ;� ,_ ,u. ������� �_l _ �_,� �_� , , � , � , <br /> ` � , � <br /> ! , , 1�� i c����iri� ..'��� ��: � .�, �� � :> 1'�, b ��� �• . ._ � �� . <br /> f <br /> �tw � 1 ��e c1Aa ,., � �� , � ,� �Lu : ; <br /> '�,; � � <br /> , <br /> - • , uSiu ., r-��,., I �o � ri'S iof ��,T� - , _ <br /> , , <br /> 7 <br /> -� I ` � <br /> ��v �ic. [�UoY k :�7y�S•�� /o/ Q/ /'HNSf b� <br /> / o ^ <br /> �'iif �'/4 ��l�,�/ [1.. �I �i'�.�.1;/' ,/�/i�� � . ./�____�.� i:�/ J <br /> � / �� <br /> _ :% �'.l . . .��1_.i � � <br /> Th�� unticisi�neA owner hereby a9rees �o hold and 5ave �armless <br /> t�tl Cily ol Ever�tt Irom .lny �no all elalms fof Oamepes, eosis, <br /> eMpenses,or causes ol aclion that may arise because ol inatalla�ion <br /> nnd mamlonance ol I�e improvement or o�her rip�l•obway use <br /> heie�o applied for and luriher agiaes lo ramove seme upon no�ice <br /> , Irom Ihe Cily and lo replace public propeNy damaped Ihareby. <br /> % <br /> ,s ' .���—�' C�_'�.% <br /> APPROVED FOR CONSTRUCTtON DATE � ArKNOWLEDGEMEN7 OF CONDITiONS <br /> APPROVED AS CONSTRUCTED DATE SIGNATURE OF APPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTfON <br /> JOBSITE 259-88� � <br /> EXPIRATION 24 HRS. BEFORECOfVSTRUCTION <br />