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everett ppp��CATION FOR PUBLiG WORKS RERMIT <br />� TYPe or Grint cleorlY with Ink $3 C <br />PRESS HARD - YOU AHE MAKING COPIES pERMIT NO. � <br />PUBLIC WORKS <br />EVERFTT, WASIiIPJGTON ?,� ��d -� BLDG. DEPT. NO. 3/' S 3� <br />J70WNER ❑ AGENT DATE ��Z�—= <br />/ " <br />APPLICANT/FIRM REPRESENTED � u� ` <br />ADDRESS 5�7.� 5� n�''�l —GTY _���TELEPHONE_'� ���� �� <br />n i7/J l. i� �_ (1 l�/1�_ <br />HEREBY APPLIES FOR PERMISSI/ON� T�'O9 <br />,i, � %! . . // b� <br />ATTHE FOLLOWING <br />Attachfive(5)copiesofprelimina�yN�a���,..�r��r�----•-� -- - - <br />* Property lines and street identity. <br />* Outline and dimensions of existing and <br />proposed structures. <br />* Exi�!ing and proposed utilities. <br />• Centerline of abutting right of way. <br />BLIC WOR <br />* Topographic changes requiring cuts and filis <br />other than normal foundation. <br />* On-site drainage systems when required. <br />* Erosion control methods when required. <br />` North afro�v ,�_. /J �., <br />PER <br />;, N_DITIONS;_. _ . --------- --_.__ _ . _.. � ___ _ . . . . . . - --...i :.; <br />O �' � <br />I. :' ;.. '. ! . {/� : ,. <br />, ^ L p�p(�1 /._1 . [� n �/ .; <br />._.- . !{�����/��IhleK-1 .0�.�-.I' IY���/,. .�..l.Jt�:�Cc��NClSC TNN�I- LS �[',.S.K1ft{Y...- . <br />�_ I io . :�syK �c..�c .oE . ���J . Pr:��..,,y+: . . . <br />' '__ � : � ' _ cin�i,ri�. 5�;-�� �I�•� re wr . <br />' P���� <br />� i � . � �. -C'c.n��l�.i�o.>>o_� {3� —� �' "'%"r.. n��._fecofc�iNc� . <br />i ! . . . . . . Q.� _�„,,, . .6�1� er �+^ �� i . ; . � <br />. ` . : �� . rr5wr�� Pf�o� {�. .IS'� ueuncG. � <br />� � . . . . . . . . . . . . . . . .. <br />i .. � �. . . . . � . . . . ' _. .. � . ,l . .. . %� .. . 1 . . �. . ( . . _ .. <br />. .- { :J . ✓•...kl'DS�O✓I...�n�i0 ��: ��i1A�1 bi • IN.S�.O�I�P.Y . G�NGF:. NtG1_�rvf. Ll�ri.P��. . W. �. t . � <br />�_�_a ., • _� . . . : .e. . � . . ' . . . . . . . . . , <br />H�t ' Sm��S�aG�-' 'n. o � . .1-�e �ublic Wcrks .-�'n� c�c�.�., i . __� <br />i � _ � . _. .__fi�_ �° _- - _ - _ _ <br />--- -- . <br />�}:�� .: i �: : ,� , � .: : ` : � �+ <br />. , � . � : . . _,_��;_� -` ' ' <br />� � -�.. f � i ,. <br />,, , .. i • . ... _... --.. .. <br />, � � � ' _. . : <br />+ t1 , , •�'�.` . <br />� � a _ . . � I <br />� i . . • { ' . ' F _ � <br />' The undersigned owner hereby agrees to hold and save hermless <br />� i ' ' �"' ���� the City ot Evereu trom eny ana an ciaims for demages, costs, <br />� -� �. 1 :� i t �! �� '� ��.�� ex0enses, or causes oi action that may edse beceuse ol Installation <br />� _�.. � : } ..r . . . . <br />� �_ ;..�_.. ...—.__ .. end mainlenance of the Improvement or olher right•of•way use <br />�� __ ...._._. _ •._.___. . .. . <br />� —' � �; , ., :; I hereto applied for and (urthar egrees to remove seme upon no t i c e <br />� .. .�; � Irom the Ciry antl to replace public property damaged thereby. <br />J j _��X//ls� .�-�'-g3 <br />�P OVED P CONSTRUCTION DATE ACKNOWLEDGEMENT OF CONDITIONS <br />� � �� �� / i,.+ . i ��7�' �a� d � .—� <br />APP EDA CONSTRUC DATE SIGNATUREOFAPPLICA�Tj � DAT <br />PERMIT IS VALID�F913 1 R CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTiON <br />EXPIRATION <br />; ,. <br />{' <br />