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-- --- - ----- ---- <br />_ <br />- -� - -- -- - -- - ,. <br />� ,! <br />� APPLICATION FOR PUBLIC WORKS PERMIT i <br />Typa or pdnt eleedy with Ink " <br />PRESS HARD - YOU ARE MAKINF� COPIES � <br />PUBLIC WORKS <br />PERMIT N . <br />EVERETf, WASHINGTON �. I <br />I, f�'OWNER ❑ AGENT DATE �!"� �? `�� BCDG. DEPT. NO. <br />— , � <br />APPLICANT/FIR�4 REPRESENTED r' -�/ '�' <` i `� ( /-' /'7 F ' ! ti L. <br />ADDRESS :, '/�� 1 / •. 1? i i'7 c".. I C�- : �-F' CITY �r L4= _�{-�'TELEPHONE � �'� �� �•' �� <br />HEREBYAPPLIES FOR PERMISSION TO �'� ` � -� �.- �-..-��',: �-��' � i `• <br />--., .i�n .�> - .. . . .. .�i /�. ����..t`�. <br />AT THE FOLLOWING LOCATION _ � `' 36/S <br />Attach five (5) copies of preliminary plans for proposed ivork Draw to scale and show the following as applicable: <br />` Property lines and street identity. <br />' Outline and dimensions of existing and <br />� roposed structures. <br />* Existing and proposed utilities. <br />" Centerline of abutting right of way. <br />• Topographic changes requiring cuts and fills <br />other than normai foundation. <br />• On-site drainage systems when requfred. <br />• Erosion control methods when required. <br />* North arrow <br />..•SlpnetureotAPPIIGnI , '_ <br />PUBLIC WORKS PERMIT <br />:: ::::j�::: .� :: :::.- -.--- ; __:.: ;:-:,-, <br />, <br />.... ., . ...., . . . � �_I�, <br />: , : . ( . ' : ��'�f (Jlt�'� : : . Q ��:r� U.P� : : � _?:�. �.�: : ! : :�: 1 : ; <br />____. ___._ �_._ ` .- - . _ _-_ . _ __ . . . . . . . . . . _._. ._ . _ __ . <br />. : . ; . . t_�____ _� _ -�- <br />_�.....�.. � ._;. .--..... .: .._.. �.......:.. � ��; <br />.�.,... . . . . . � . <br />. . ------1_ . . � \. (-� . . � . , � . <br />._. 1 � . . � �,YPS,� v+ �o.�:�Yo. � . � e. w�a�vain�Hr�:Y . . . . . � <br />:., ._: . �� .. ... <br />--� _�_ . - ._ 'N ._i.�� �r_�`_ l%�'S�_��-�': �.-�. - - -F-;1 �s-$ S�_—~--�---' <br />+ �—� i <br />� , i <br />{ i :.� � ` f,P.wov.c,.� ;�� :UPt�L�.�cl�,:, ��`-' ��� (l°�yi.�Yc� , . . <br />� . ' ( ._ P�qc:._ew�f'� O� � I2n1ES. .�:^� .rC�f'.F �.�w. � . <br />� . . :_. 1� . . . , i . . I ( (� . . . . . � . ; <br />� �� f /� 1 � <br />�! �� c �.S c�'t��siY d �:'t'���.-1 �o� r- �`��e �1� . L�� .�in ��r-F i-or <br />...�.!.i . ... ... ........... .. . . . .... ........ ,.. � <br />— ---i —�— �� TI ----� ---._: .___._..;- .--�--'� -- • -•�-'--- � - • . . �. . . . . . . <br />, . , , . �.-. ` 1 �, . : . . : i � , , 1 . . . . . . . The undersigned owner hereby aB�eas to hold and save hermleu <br />: . . : : : : ! , , _ ; : : 1 : : y . : , � . : . ; . I�e Ciry ol Everett trom any xna all clalms lor dem�pe4 eottti <br />4 1 . I. expenses, or causes of aetlon thet mey arlee bec�uee oi Inehll�tbn <br />-- ---- • � --- +- � �� � • - � � • � � • �- -� - -� � • • • � � - � � � antl maintenance ol the Improvemant or other dph4o4wey use <br />• • • � � � • � • � � � • � • • � � � • � � � � � - � � � � herato epplied lor and lurt�er aproea to remme ums upon notice <br />• � � • � � � � � � � � - � � � � � � - • � ' ' Irom Ihe City end lo replece public property d�m�ped thereby. <br />i . .�✓".� _ . . . . : . . . . . . . . . . <br />.�-"/" /7/� ,-` y <br />� "ii`"( ���!! `4�zr�tl-�Iv.'0 � <br />4PPROVED AS CONST1f1UC <br />PERMIT IS VALID <br />EXPIRATION <br />TE ACKNOWLEDGEMENTOFCONDITIONS <br />�r �1 'c . , , �;„ :( � <br />TE SIGNA � REOFAP LICANT OATE ' <br />1 YEAR I I- CALL FOR INSPECTION ----� <br />POST ON 259-8811 <br />___- JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />