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� <br /> ; � <br /> , - <br /> everett pppLICATION FOR PUBLIC 1l�+IC�'RI(S PERMlT <br /> � TYDe or P;:nt cleaAY wilh ink -� <br /> PRESS HARD-YOU ARE MAKING COPIES pERMIT NO. _ �_—�,�- <br /> PUBLIC WORKS BLDG.DEPT. NO. �3�� 1�2--- , <br /> I-' EVERETT,WASHINGTON <br /> �OWNER ❑ AGENT DATE —.1/2:/R� <br /> ���°ISTOPIiER L_VALLO <br /> APPLICANT/FIRM REPRESENTED � 3j3-R487 <br /> CITY Fver�tt TELEPHONE <br /> ADDRESS ° <br /> HEREBYAPPLIES FOR PERMISSION TO _ � i e famil residence <br /> ATTHEFOLLGWINGLOCATION To�'rnort Asres -��� <br /> ,rc 1��, A�e.. <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the tollowing as applioable: <br /> • Property lines and street identit;�. * Topographic changes requiring cuts and fills <br /> • Outline and dimensions of existing and <br /> other than normal foundation. <br /> proposed structures. * On-site drainage systems when reyuired. <br /> • Existing and propused utilities. * Erosion control methods when required. <br /> * North arro�r � /�� <br /> * Centerline of abutting right of way. � / , / /^ �� <br /> // <br /> Slgnature of Applicont <br /> PUBLIC WORK�► PERMIT <br /> CONDITI.ONS; . _ _ __ _ . __ _ <br /> I " 1 1 �,�-1���� <br /> i . . ' � . �..�. .Rl�l . roo.£ �' clCiUewn� . c�fn�.wnS 't MN9f �Je -T�S . . . <br /> '� �. �. . . . � . : . . '� ��f� 1/�e-��S �tvr . ^1'�c:'✓.Jn ClY<+� �v� 5 Or} �o-�o . . .. . <br /> � w.,l,.., I . d.-�,� �.Sr_ �,... . <br /> C:a�.�: . �s. . :hL -�,_1�:t�. � . <br /> �. . __ . _ . P P `1 '�..G�-"- ecz5-� <br /> i� . . ( � .._,4- ro e..�' �. <br /> � _ � . , � . .�ANnA!'tA� 0.cA`CLGG . . . . . . . . . . <br /> V <br /> ,�, �.�,� P��ti 1:� �/w <br /> ,�� ar.ue��a.� w, ,.. , <br /> . . --` �2.. �oc�w•-. ;c� � � i. <br /> n � <br /> , <br /> _ . _._. . : w'a"�; 1- ba- �a.v: rY. . • , —1 <br /> j . . . <br /> � . . . : , _. . _ . . . � . . : � ' . . . . , <br /> . . <br /> _._._ ___ . ... . - . . <br /> L._._ ._'_'__..-. j r � . . <br /> i . . . . . . . i , - � . . . . . 4 . � �: . . . . <br /> �. ; � � '1 , . i .. . . i • <br /> ' � �-��� � � The undersignetl owner hereby agrtes to hold and save harml�3ss <br /> . . - - r _`_".r. . . . <br /> .. l � � • ' ' '` ' ��� � ihe Ciry ol Evoreu imm any ana au claims for damaBes, cosls, <br /> �. . . . . . � . � • . � ' ' • ' ' ` }��' � ' I� , � ezpenses,or causes ol acUon that may adse bncausn ot instellalion <br /> � • � � ' ' ' � � � ' and main�onance ol ihe improvement or other ri9hDof-way use <br /> � � � � � � � ' � he�^_m.ep4lietl for and further agrees to remove same upon �otice <br /> � � � ' � - ' ' � ' . irom the Ciry and to replace pub�ic p�op6�y a2�ieBed Ihareby. <br /> � ��r 6��,�G"��. `�'f'3 / J <br /> �- p gp-pfj�NSTitUCTION DAT ACKNO FDGEME OF ON IT NS <br /> ! " � `j� <br /> , , ti o <br /> �„ < <br /> �-- �1.:� �� DA � SIGNATUREOFAPPLICANT __ <br /> qppROVED 5���..N�� CTED � <br /> _--- CALL FOR INS�ECTION <br /> PERMIT 15 VALlD FOFt 1 YEAR pOST ON 259-8811 <br /> JOBSITE 24HRS. BEFORECONSTRUCTIO J <br /> ' EXPIRATION ---r <br /> _.? <br />