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A <br />— � o __.,-- Q � <br />– _.___— �1 i' �e�'v�n .� <br />everftt qppLICATION FOR PUBLIC WORKS PERMIT <br />0 rroe or v��m aea�ir wun i�k p <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. o� <br />PUBLIC WORKS BLDG. DEPT. NO._ <br />EVERETi, WASHINGTON <br />� OWNFR ❑ AGENT DATE - IL�'� <br />�, qpPLICANT/FIRM REPRESENTED — -IC,�F�+'-"��"���� C-� <br />'' ADDRESS �—��n-"�--•`"� C�TY -��'�-TELEPHONE.�3�.,1�� <br />� HEREBY APPLIES FOR PERMISSION TO � <br />ATTHE FOLLOWING LOCATION <br />i3c7/ I�ka?�l�rv.s Q/� � U6v�7T'— <br />Attach five (5) copies of preliminary pl3ns 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 utillties. <br />' Centerline of abutting right of way. <br />LI <br />� Topographic changes requiring cuts and fills <br />other than normal foundation. <br />* On-site drainage systems when required. <br />* Erosion control methods when required. <br />' North arrow _ <br />r � <br />_��� � / r/�)�� <br />�89n lure 1 Olwant <br />KS PE►iMIT <br />eONDITIONS; _. . . . . . <br />�_"" } , /.: . �o�xir....w� :al�o�:�a61c. �,11 -% ��� Yc�? . . � . <br />' ' is. �ok_ -% be. pla.e�� �n� l�e� -F-1n�,�_ ___.� . . <br />2: _ _�'ill . � I' � 1 <br />�,. i . '. �. , �. �. - . .' o � 'i�. �tn e . S o wY� � S o . 0. � vi o t � � � � � ' ' . <br />iit'r ..�..... � ...-- '...... <br />�._ '�:-.-� --- ; . . bloc� uia�vt.rG..� : cir c...-. a Sc Pc�iaec.,.s. . . : <br />� � . !�� c� Fa r .J , -� <br />_-t � I � . <br />� I -�(HSN ,15..no�. . ... _......... --- . <br />' Oin� O � °�- <br />...' � �., . . . S•I _.'.. . <br />_ _ . . - eRs� . J�. .����P{� �'�i rt� _: <br />i,� .. co � i-no l a s n'e ��P.� w � I l b c i n s�-a ll i./� : <br />. lj.l Eros�o P � <br />__._. . . , . . . ..�.o y-lne. �u,l,�s�.���o;, o-� �Ii�e . ="'��e«�i- <br />: : : . . ; . . ._:_ . . : <br />-- -' The undersi9netl owner hereby agreas 10 holtl and seve hermless <br />' ,~ � '^� � - - ' ' � � ' � � ! - � the City ol Everelt irom any end all clalms Inr tiamages, c�sis, <br />� � � � � ' - � � � � ¢rpenses, or wuses ol aclion Ihal may adse becu;fse ol Inaiallation <br />�� ''� '' �� and mnintanunce ol Ihe improvemenl or otbar riph��ol�way use <br />'�-'� ��� herero applied lor antl lurlher agrees lo removo aame upon nolice <br />� �•�. � � �. . � � ��. . . . . . . . . ' � . . . . Irom Ihe CiIY and lo rePlace Public PmPertY dameBaA Iheroby. <br />; . . � �-�/ �z <br />; <br />/ � DATE ACKNOWLEDGEMENT OF CONDITIONS <br />PPROV�D�FQ CCkI�RUCTION n � I ,� .�. �'� .-y C_ i._ c-� <br />PERMIT IS VALID <br />EXPIRATION <br />1 YEAR ` CALL FOR iNSPECTION <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTI�DN <br />