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I <br /> I <br /> (- ' � , _T-T -_ �_ _ . ._.____ .._... <br /> I I <br /> �e"`re" APPLICATION FOR PUBLIC WORKS PERMIT <br /> TYPe or print clearly with ink O <br /> PRESS HARD•YOU ARE MAKING COPIES pERMIT NO. o� a 3 I <br /> PUBLIC WORKS <br /> I EVERETT,WASHINGTON �� Q� � I —� <br /> � BLDG. DEPT. NO. ! <br /> ! ❑ OWNER ❑ AGENT DATE �_� Z- I <br /> APPLICANT/FIRM REPRESENTED V��5 � • �J U � <br /> �=r_'4� <br /> ADDRESS �IS �I C� Y �SCPbI�' A-VP CITY �UP �P� TELEPHONEaSJ ' 3oo0 i <br /> HEREB�APPUES FOR PERMISSION TO `��P A�� C�� �K i 5 f� ��D� i v � W o� i <br /> ( l <br /> "CU V� ��C C..� C4G.V Q S '�' ' <br /> l /1 �I ,L� <br /> AiTHEFOL�OWINGLOCATION �S lr t '. YrS �'PNI- /�lu� _ � Ur .rP / ' <br /> � <br /> , Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: � <br /> I ' Properry lines and street identity. ` Topographic changes requiring cuts and fills � <br /> ` Outline and dimensions of existing and other than normal foundation. ! <br /> I proposed structures. * Omsite drainage systems when required. <br /> � ` Existing and proposed utilities. ' Erosion control methods when required. <br /> j ' Centerline of abutting right of way. " o h arrow <br /> �� cL�rt.eQ_� - 13��� <br /> �i Signeture ol Applicant � <br /> ' PUBLIC WO S PERMIT <br /> CONDITIONS: <br /> i � . <br /> � <br /> � . . _ . . . . . I <br /> i I ; . � . . i <br /> � <br /> . , . . . i <br /> , . . . . . . <br /> � <br /> �� . i .�' . -... ._._ . . . . i <br /> I � � - � � �.;_ . . . . . . . . . . � <br /> � �r , . <br /> , . . . , _ . . . � . . <br /> � . . . . : . : � . . . . , . <br /> , - ; � <br /> _ . .-r---_._._.____--,-� . . . . _ . . _ _ . . . . <br /> �i� . : . . . . : � : : � ; � : : i . � <br /> -- ��.:� ..�_ : <br /> �:y.. . . . , , . � <br /> . : ' : : : : _ : : ' . , <br /> � � <br /> � <br /> , i , I <br /> i � . , �—^-.- � . . The untlersigned owner hereby a9ree5 to hold and save harmless <br /> li � . . ;_.�-: , tho Cily ol Everett Imm uny anU en aaims lor damages, costs, ���, <br /> � . � . . . . . . expenses,or causes ol action Ihat may arise bacause ot Installation ' <br /> i � — - • � � � � � � and maintononce of Ihe improvement or other righl�obway use <br /> . , • � � � � - � herelo applicd lor end luriher aprecs to remove sume upon nolice ' <br /> �, ' ' � � Irom Uie City enC to replace puhlic property dameged thereby. � <br /> ' „�=Y/�-Zi::;ii/ a -/- � z L ' ! <br /> � <br /> � /A'PP VED F CONSTRUCTION DATE A KNOWIEDGEMENT OF CONDITIONS � �' <br /> i -r.v 7—Z� -o� �v�a �- ��c_�-�:-,_� `� y s'Z <br /> APPROVEDASCONS R TED DATE S ATUREOFAPPLICANT DATE . � <br /> , PERMIT IS VAL FO 1 YEAR pOST O CALL FOR INSPECTION <br /> � - / �3 JOBSITE 259•88i 1 <br /> . EXPIRATION 24HRS. 8EFORECONSTRUCTION <br />