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. ` _ <br /> -, <br /> I <br /> i ' <br /> eV� APPLICATION FOR PUBLIC WnF�KS PERMIT <br /> iype or print clearly with ink <br /> PRESS HARD-YOU ARE MAI(ING COPIES pERM1T NO. g y � <br /> PUBLIC WORKS _.. I <br /> EVERETT,WASHINGTON BLOG. DEPT. NO. �a 3 <br /> ❑ OWNER BAGENT DATE 2���—�_'�—' _ <br /> APPLICANT/FIRM REPRESENTED _�=i.L�N��_�f'�-Tr�Z-- - -- — <br /> ADDRESS �yU� �U�2£7'/�-Ut. CITY ����� TELEPHONE��."'G/0 6 <br /> HEREBY APPLIES FOR PERMISSION TO u-�� �X/ST/RJG- / / �/�E-�A�� <br /> ATTHE FOLLOWING LOCATION _,.r_I_-_� �%Y� ��'e--- <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. ` Topographic changes requiring cuts and fills <br /> ' Outline and dimensions oi existing and other than normal foundation. <br /> proposed structures. ` On-site drainage systems when required. <br /> ' Existing and proposed utilities. ' E�si n control methods.w en required. <br /> " Centerline of abutting right of way. ' ort arro•N <br /> ���� � <br /> - SiBna ure ol Applicen� <br /> PUBLIC WORF�'S PERMIT <br /> r <br /> CONDITIONS: <br /> r' <br /> . . . . �'OOt -�'D/� , GC�A�HG ¢ 15 -�o bP OO�n '1(DIIP�� O.n -s � �7 � <br /> �J 1 <br /> . . . . . . . . . q v� �/ \ S v� o � . 1 S C Ia G' f ` :' �'� L(O S S S 1� P W a 1 IL <br /> J <br /> � : <br /> . .._._.-J:. . <br /> ;__ ..J.-..." <br /> i . -�. . . <br /> � � � <br /> i _ . <br /> � <br /> i � � � <br /> ' "'Y—'� � � � � The untlersigned owner hereby agrees to holtl and save harmless <br /> . . . � <br /> ; � � the City ol Everetl tmm any ana au claims lor damages, cos�s. <br /> - expenses,or causes ol aclion thal may arise because ol installation <br /> � . and mninlenence ol the improvomenl or other riBhPof-wny use <br /> � . . . heret6 applied lor end lurther agreee lo�emovo same upon notice <br /> " �' �mm Ihe Cily and lo replace public property dameged thareby. <br /> ` <br /> r � � - .2� •cYZ <br /> �--����--��� _ _ ;, ,) �� <br /> �t�PRO D FOR CONSTRUCTION ATE AC WLEDGEMENT F C ITIONS � <br /> � .� ��j Z -_ � ,�_ � <br /> 0 <br /> APPROV D AS CO TRUCTED ATE j� 81G ATURE OF APP.N ANT DATE V ' <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTION 3. <br /> 259•8811 <br /> EXPIRATION � � � "� h 3 _ JOBSITE 24 HRS. BEFORECONSTRUCTION � <br />