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t' <br />� <br />. ... _. _ _.. ____ __'______. ...-__-____.._ -_� <br />�everett qppLICATION FOR PUBLIC 1NORKS PERMIT <br />TYDe or Print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. �� � GI <br />EVERETT, WASHINGTON � BLDG. DEPT. NO. 3 I�T S.� <br />❑ OWNER f�AGENT DATE �2-1-� � _ <br />APPLICANT/FIRM REPRESENTED �'I I�l��u `� <br />� 1 <br />ADDRESS `�LL�1� ( Ur�.[NNr��� CITY <br />HEREBY APpLIES FOR PERMISSION TO _ <br />TELEPHONE �y; )��L <br />ATTHEFOLLOWINGLQCATION �aaO Ma.CI1SOv� <br />Attach five (5) copies of preliminary plans for proposed work Draw to sr,ale 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 right of way. <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 />rut�uc woRKS PERMIT� <br />GONDITIONS;. __ . <br />_ _— . <br />� .: .�. <br />� .... . , .� �Cctie' cr�tP� �-7'io.-i � /�B�-i-.n ��� /f�.L�r.r�Pc� , . . . . . . . <br />�...�..... . /.. /. / / . . . <br />. . . . . . . : . . . /f'fui-r-(S � �S�h:G.i.,,, cF���TiO.-� �.�i/�. . 6� . O . .i. . . . . . . <br />�.___.-_ ..... . ._ �Xls"�1.41 . _��.I</e S�wF��/� . . . . . . . . .. . .. . <br />uP <br />I.. ..:.�.. ...�.. -. . ... ........................ <br />i f� 5 �C- L - � � �" !� G � <br />; <br />. : �: . ti "�� . v„v�c , . �j U.� .� [� /4 5 f',�Ch�.S ( � c�e- <br />f <br />_: � _ z� �«�ti���J . <br />r <br />' . � . . . . . � � `�� L� � . . S/Cl/� i . <br />I • , . .. �.. <br />� � J� <br />.. ,_._ �_�_.. . ... <br />..� . . . . . . . . ._ . _ . . . ./ . . . . . . . . . . . ! <br />� . � , , � . . . . _ . . . <br />� . . . � . . . . � , . . . , . . � . . . <br />�i . . . . . . . 1 . . . . . � . ' � . . . . . . : - <br />: . � . . . � . . . . . . <br />'_ _ •_r . �t-.'^ '.-_ '�_. ' ' _!'_______ . . . . <br />- ' ' ' � � ', �� � � � j � � ~ • � . ., . � The undersignotl owner here6y agrees lo holtl antl save harmless <br />� ; ' ' ' ' � � ! � � � • � � � . � - � � � • � . � � �� � � Ihe Ciry ol Evere.tl trom any ana all claims br damages, wsis, <br />� ' ' ' ' ' ' - ' � - � ' ' - � - � � - � � � � � � � e:penses, or causes al action ihat may arisa beceuse ol installation <br />� � � � �" ' � � - - � � � " � � ' `�----' ' � � � - • - � and mainlenence of ihe improvement or othnr riphl-obway uso <br />�� '� ': ��� h�relo applietl br and Wrlher egrees �o remove same upon notice <br />/ Imm iho City and to replace public property damapetl ihereby. <br />��'�-%����,�-� -.� .� 3 <br />�APPROVED FOR CONSTRUCTION DATE ACKNO LED NT F CONDITIONS <br />�-� �- �%- fi'3 <br />APPROVEO AS CONSTRUCTED DATE SIGN�URE O�PPLICANT DATE <br />PERMIT IS VALID FJR 1 YEAR <br />EXPIRATION <br />POST ON I� CALL FOR INSPECTION <br />JOBSITE 259-8811 <br />24 HRS. BEFORECONSTRUCFION -' <br />