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____i <br /> _ __ _ _ __ __ _ _ _ <br /> - - - _ _ __ <br /> _-- <br /> ; , , <br /> , , , <br /> � , �� - <br /> P"e`e" APPLICATION FOR PUBLIC WORKS PERMIT <br /> I � TYPe or Prinl clearlY with ink �. <br /> I PRESS HARD-YOU ARE MAKING COPIES �� 3 <br /> PUBLIC WORKS PERMIT NO. <br /> EVERETf,WASHINGTON BLDG. DEPT. NO. D a a 6 -- <br /> ; ❑ OWNER ❑ AGENT DATE I I F-FR-�' �'� ' I <br /> I APPLICANT/FIRM REPRESENTED Q LS� �Yo 5 Z � � <br /> IADDRESS �• � ' V�'�''� ��7'S CITY � v TELEPHONE 3 3 7'3 �-S�f <br /> � HEREBY APPLIES FOR PERMISSION TO �-d � O W ]�o � k 5 i 5 ) � ' t�-.; ,C�ti�V e W N.� i <br /> I <br /> ! � i l� i- .- .�:.._-.�_-�-T7�� <br /> i <br /> � ATTHE FOLLOWING LOCATION �� �^��—"�-��"��---'��-�'�f <br /> I� Attach five(5)copies of preliminary plars for proposed work. Draw to scale and show the following as applicable: <br /> li ' Property lines and street identity. * Topographic changes requiring cuts and fills ' <br /> � " Outline and dimensions of existing and other than normal foundation. <br /> ; proposed structures. * On-site drainage systems when required. <br /> ` Existing and proposed utilities. * Erosion control methods when required. <br /> II * Centerline of abutting right of way. * North arrow <br /> ' ������� <br /> � T Signature ol Applicant <br /> i PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> i ; . . . . <br /> � ;_: /.�' ;J��.S ��i'a�.f� 3`��2- <br /> i, . , . � . . <br /> , , <br /> , _ . . . _�__ . <br /> i _ _,_ t .._. . . . ._. . . . _ _ . . <br /> I —� : : ' . <br /> , . .i _. . <br /> 'I � - ' . � ': � � :_� <br /> � � <br /> -� -� -+-- <br /> � � : � - <br /> � - . . , . . <br /> -� : : ; � : � �: , - : � <br /> _ . , _ �_ ___ <br /> ;� -r - � <br /> � . . , � � ;_ S <br /> . , , <br /> — -_ �-- - ' --- <br /> ��� , , The untlersiynetl owner hereby agrees to hold and save harmless <br /> � Ihe City of Everetl Imm any antl an clelms lor damaBes, costs, ] <br /> �. „ . . . . . . � expenses,or causes ol action that may arise because ot inslellalion\} <br /> - . . ._ . . �. . . . . . . � antl maintenance ol the improvement or other righ4c'•way use �� <br /> , � � - � - � - � � hereto apO�ieA lor and lurther agrees to remove seme uG�n notice <br /> �� � � - � - � � ' trom ihe City and lo replace public pmperty damage9 I�ereby. <br /> / � • _ 3 � <br /> i A-f'PROVEf F N TRUCTION i ATE �/ ACK OWL DGEMENT OF CONDITIONS - -� <br /> - ' �� /_ Z�0 �- �� � C� �� � <br /> ' + (i- �/ Y� / � Lt. i _ti-.� . <br /> I APPR � RUC ED� DATE �SIGNATUHEOFAPPLICA DATE i <br /> � PERMIT IS dALID F - R 1 YEAR CALL FOR INSPECTIGt�i , <br /> POS,T ON 259-8811 <br /> I EXPIRATION �����.���� JOBSITE 24HRS. BEFORECONSTRUCTION� <br /> _ _ _ __. _.�_ _— - -- -- --- — ----- ------ - - -- - _ _ -- - _ _ <br /> � <br />