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� . . . . - � . _ _ _ _ _ ___ � I <br />� , i <br />"'�'°" APPLICATION FOR PUBI�IC WORKS PERMIT <br />e TYPe or Pdnt clearly wl�h Ink <br />PRESS HARD - YOU ARE MAKING COPIES pERM1T NO. �� �� 9� <br />PUBLIC WORKS / ' i <br />—EV/ERETT, WASHIh�.TON /v ` 5 �I � BLDG. DEPT. NO. '``-�' <br />CT`OWNER ❑ AGENT DATE _ � <br />APPLICANT/FIRM REPRESENTED �IN� 6kCG N S7FcC• G%� \�` ------- <br />55/.5 ,�i�5> �.e'�vC `� J' <br />ADDRESS CITY ��TELEPHONE �`�'79�� <br />HEREBY APPUES FOR PERMISSION TO ��" �-1% �L /� 5� �.1 �� ��S �� C r.. � � <br />Cvn>si2c.c� 13" C'R�sfIL� J2Gcl� t�R��c- wn� <br />ATTHEFOILOWINGI.00ATION �.eT IQ 'C� � ����,�������) �Ic(jL�� <br />.55�:/- E�s f LL: E✓c:r�� 1*/r.. 96'Zc.i <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. <br />• Uutline and dimensions ef eristing and <br />proposed structures. <br />* Existing and proposed utilities. <br />' Centerline of abuttir.g right of way. <br />LIC <br />' Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On-site drainage systems when reqi�'red. <br />` Erosion control methods when required. <br />' Nocth arrow <br />�yc._r� �7� ��Ll/t`-IG.� <br />SIOna��ire of APPlicant <br />CONDITION.S; <br />i�.. ...1... ALL P.O�k' DAAILJF MUST TIE I17T0 DRY4:F.LLS. <br />� • •3� � URY{vL'LliX TO 'Bi ,.MINZtdUt1 ��F :'x('?�4' dcep <br />� . ... .3_. � THAT�. PORTIOti OF ,TUE. URIVLhAYS S:IT':I?' .^!rr <br />i . . , . . . CE PAVI:D., . . . . . . . . . . . . <br />k-� .: `.:�: ..t_ :::: :� .�,� <br />,: {_,. �:� .::: ��� � <br />P.i1ALIC RIGIiT� OP �tiAY �MUSfl' � � • � <br />;:.:::::.:::f. '� K- P <br />' � -_ :_�_� _ : � :��_ : : �. . . . . � : �� . . � !; <br />._. .. ,... � � o <br />., � <br />—.— -- --_. �.�_:... i . ; � � � ( l , rY • . <br />. ;.,,,:._'.��jl. <br />I r, • . �I .: . : . . . .: . : .. ;_._1 <br />. .....i...�., <br />�:� ...;..... <br />, : , - i -.-, <br />.. .,.. <br />.;.... . <br />.l...t.: <br />I . . . . . . : . . � t '..' ;�,� � . <br />, . . ... . . � . . �.. .�� � <br />,___� ...��._._ <br />..�j�T , y� ' . � � , 7he untlersignetl owner hereby agrees to hold and snve harmless <br />� the Cily of Everelt trom any ena an cialme fo+ damapea coat0. <br />i ' � e�pen5es, or cause5 01 BCIiOn Ihat may eribe bacause of inatall0lion <br />� . . . . . . . . . . . . . . . � <br />, ,. .._. . . . ... .. . .. . . . . . . . . . - . . . antl mninlenance ol t�e ImD�ovement or other rip�t•obwey uee <br />. . . . . : i . . -. . . _ . . . . her:to epPlied br entl lurthar agreee lo remove same upon notice <br />�-�� ��� � � � •� • Irom Ihc Ciy antl t�• mpluce public property demapeC Ihereby. <br />; .-�7�. j' . : . . . i! �+ . . . �t <br />��--�tl/i%.LT i�,��t---�-- �n/7 �!/ <br />�'AP ROVED F CO STRUCTION OATE � . ACKNOWLEDGEMENT OF CONDITIONS <br />.. i � ..,.-, iG , <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR �% <br />, �OST ON <br />EXPIRATION �� � � /k� JOBSITE <br />CALL FOR INSPECTION <br />259•8811 <br />24 HRS. BEFORECONSTRUCTION <br />r <br />�r <br />I <br />