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eVw "��� APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with ink <br />� PRESS HARD YOU ARE A�AKING COPIES �.' <br />PUBLIC WORKS PEfiMIT NO. � �%I �7 <br />EVERETT, WASHINGTON BLDG. DEPT. NO. <br />❑ OWNER �AGENT DATE .,/0.23_ �i <br />APPLICANT/FIRMREPRESENTED `�'1,Pe'� /C%i[.ci� <br />ADDRESS_gZ-�' �v'.c'�i=%������'=v�At CITY��/�'c-�%-%TELEPHONE�.JS"4�l�= <br />HEREBY APPLIES FOR PERMISSION TO �/�f�7/a� c- � �� �" <br />� G�l.t� i%c=.� i �1 n�/� 7< '� <br />/ !/iJ!' � �f� ir^/y %f/�//V� ./�/,// � G G �ic�G�,C.�T'� <br />AT THE FOLLOWING LOCATION -%%-�' ���'f"=%�i�=�= -=?r' �(%/_=.E.�c'.-':' /t'�AC c GG� Y< 7� �L't' <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 />* Outline and dimensions of existing and <br />proposed structures. <br />* Existing and proposed utilities. <br />` Centerline of abutting righ! of way. <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />` On-site drainage systems when required. <br />4 Erosion control methods when require�. <br />* Nortlt a�low ) � ,.� <br />QON.DITION.S; . _ . .. <br />. _ . _ . _. <br />t..: . <br />�.. .... _.. <br />i _: �' . F`%� � . . .i�J ��<<f.��-?i� E' l.vl7'�i' f�3"'��rz � . �'G!.�.3 .c.�i`� � <br />, . . �) z�' �'/. <br />. . . . . . . . . . . . . . . . . . .". �'~����i - :J � .'l�����y� � .��,. ti��� o- <br />k._�' . _ �4'� /!�-'�C'% _ . /�/�r . . _ G�l /C < _ . �J'c . 1' �Y�,f.hi'7�u lC1 1 :2'�L'�G�Z.�'c.'> l C. lt:Y.�i��'r.Z!8'�iGFS'�'� <br />� . . . . ;��.��$�UT <br />;......... <br />j -3t". : f .T. . i%l?%. . . �'r . /�� �'��iy c/�c= !�'�"c v�/�7c - JT -- G�'�'a/`�c%.-'� <br />; : : : : ou>jVE;� ' Gl�/� L �c C�j�,�L r : . /� ,�, e� i rj/c.0 : <br />� . �_ ..Q �,lU.d�.O.c`_: viJ :S:/.T_ .c./�C i..�iJ7(wiJ �_iiJ!'tt.,or-. :�'z'� . . <br />�--_. --_ .. <br />. . _ � . fJ,l�-`.�? �c1iJG Fi«r—;p ,o�,. : <br />... <br />; . . . , . . , ' . . . . . . <br />. . , . . . ��, ., . <br />- ._: �._.�../.. �/iy/.�7E; ✓�: . lN.T.?. .T/S£--. .G�?�:�•C �°<ici�. �-�ko�. fi' <br />. � . : . ; . �� ��+'�%J'f'v. ci/'oiJ T"H� Los.f' of' i:Sco C'U��c� /'c.-c:�-- <br />f . . - -: :. _: _ . : . : � .F. . i�l�i.�!e�i`L4 :,'� .Oo.,toiiJG. <br />����, _� The undersigned owner hereby agrees to hold and save harmless <br />.�. ��1"�� ./f�iC�/n� fjL�?/T.J^� .7� .. lhe City of Everelt rmm any ane au claims for tlamages, costs, <br />�� .��f�.� �`��` _ f,n,� �� ����� � expenses, or causes ol action Ihat may arise because ol ir�stallation <br />� '"���rt% and maintenance of the impmvement or olher righho4way use <br />� � ._ . � � � � � � � � � � , � � � � � � � � � herelo apD�ied for and Wrlher agrees to remove seme upon notice <br />� � � � ' � � - � � � � ' � � � � - - iram the City and lo replece public pmperty damaged i>ereby. <br />.�' � -' aa � <br />�= ; <br />APPROVED F R"C � 7AUCTIO) DATE ACKNQWLEDGEMENT OF CONDITIONS <br />/ ��� i <br />`�_.._ it:r�z� i��i�l,r�� !.>' �% �� <br />APPROVED AS CONSTRUCTED DATE � SIGNATURE OF�APPLICA� DATE <br />PERMIT IS VALID FOR 1 YEAR <br />�_ EXPIRATION ��`�� �� <br />POST ON I CALL FOR INSPECTION <br />259-8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />Yj]' <br />C <br />