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;;:< <br />e"e'e" APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYPo or Print clearlY wi�h ink <br />PRESS HARD - YOU ARE MAKING COPIES pERMIT NO. � y �� <br />PUBLIC WORKS q� <br />EVERETT, WASrIINGTON �/ BLDG. DEPT. NO. �^� �4-3 �� <br />[�(OWNER ❑ AGENT DATE �/%�Z'�� �r �9�Z <br />P,PPLICAhT/FIRM REPRESENTED ��N�K C �G!%�/C�' <br />ADDRESS 7'�G.3 LGGUE� F/DGE T�D�� `I8ZG3 C�7y �VCfZE7J" TELEPHONE �S3-SB.iZ <br />FIERE2YAPPLIESFORPERMISSIONTO ��UD 2� STQ2�/ ADDI'TION� iAl('/l/OFc <br />.2 t�EDT1GOMs / �Tu�Y i 3�4 C3f1Tfl <br />ATTHE FOLLOWING LOCATION ��C%3 �wE1� ��DG E��� /Cl/EI2E7r 95��[J3 <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. * Topographic changes requiring cuts and fills <br />* Outline and dimension� of existing and other than normal foundation. <br />proposed struct�res. * On-site drainage systems when required. <br />' Existing and proposed utilities. * Erosion control methods when required. <br />* Centerline of abutting right of way. * North arrow <br />, , <br />7�� ��� � <br />,.�• �6� � �'C•�� u � _ <br />Signature ol Applman� <br />PUBLIC WORKS PERMIT <br />CONDITIONS; , _. ___ .__ --- <br />i... .:...... .. .�. ;y <br />'� , <br />i .....; . . . _, <br />, <br />, . ,. , , i <br />� _� . . <br />.:....... ._ ___. <br />�.. } � <br />. ._. _, y _ :.� .. ... __ . 7 . . .. . . . . . . . � . . � r . . . . . . � <br />� t �--�'r f � � } . . � . . . . . . . . . ' . . . . , i � t ., �y � . <br />� - t t . . . � . � . <br />. .. � .. . . . . . . . . . . . . . , �. . 1 <br />' i <br />. : . • <br />, , � . �_.�..._�.._ . - __"- .. _.._. ._.._ . . _. _. _.._._� _ ..__._.- <br />___"_' . .._. __ _. � . , <br />---7-- <br />. 1�. . . . � . . . . . . �.. . . . . . . . . . . . . .� . . . . ~ � . . ... �.. i <br />� ' .. y _r . . . t . . . . . � . . . . . . . . . . . . . . . , j. . . . . . <br />� . � . t ' ... . t . . . . . . . . . . . . . . . . . . . . . , . . . , . �. � i . ; <br />; r. i .-_j _.. _ . . _ . . . . . . , _ 7 . -, <br />I I-i � ` ; t.. 1_ ;. . ' � i <br />�i; ;�,.� ,.. f . . .. , . i , <br />_ , <br />��t_. .. �. ,.. <br />� ���_____.�_�--__ _f __ _ �:_ .� _-� � ��_� . . <br />�-;- � -'...;.. ..;... .. .. .fi .. �--� <br />_ <br />. <br />y.._...1 � �. • 4 .� � I . ' . . . . . . � � . . , . � . � . . <br />1 i + t <br />�.. - . �� ' ._.�� .._..«_ f —.. ...... . . . . . . . . . . . . . . . . . . . . . . . ..... . .. . . <br />1 1 { .. <br />i '-_ �. t ; � � .. . . . . . . . . <br />. . <br />� . r t . . . . . . . . <br />� _.� . ( . , � i . . . . . . . <br />i— <br />j � ,.. � -�� �� � The undersigned owner hereby agrees to hold and save harmless <br />I:�} �� I � .,, the Ciry o� Everett trom any una an cloims tor damages. costs, <br />{ '; . . . . . . . ..1 , i . t �. . . . oapenses, oi causes ot action ihat may arise because of installalion <br />,__;.. _ � _........_. ... .. .. . _....��_- -.__.,_.. . . . . . and maintenance of �he improvemenl or other righ4obway use <br />,:� <br />. ; . . . • � . . � . • � � � � � - � � � here�o applied for and luriher agrees lo remove seme upon notico <br />Imm the Cily and to replace public propetly dameged Ihereby. ' <br />._ �, . : ����v <br />, - �-: ,�� <br />�P� -ME OR.� ST, CTJO�N � DATE ' ACKNOWLEDGEM OFCONDITIONS � <br />'` � Cl �� � � <br />� ''�-� lv—/—�Z- � <br />'PRO EDAS NSTRUCTED DATE �IGNATUREOFAPPLIC NT DATE �. <br />P�RMIT IS VALID FOR 1 YEAR CALL FOR INSPECTIVN <br />I POST ON 259-8811 <br />�� EXPIRATION �/Z�A� JOBSITE 24HRS.BEF�RECO�ISTRUCTION <br />— --- -- ------ - <br />� - --- - - - -._. _ _- ---- -------------------------- <br />�' <br />J <br />