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�-_ <br />.,:_ <br />■ i_ <br />------– -- - <br />— — --- - <br />_ __. . ... _ _. __ _ __ --- 1 <br />�e"e`e" � APPLI�A'..ON FOR PUBLIC �NO�.r(S PERMIT <br />TYOe or print clendY wilh ink <br />PRESS HARD - YpU ARE MAKING COPIES pERM1T NO. `T �'' /j '� �) <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. NO. �%y "� <br />❑ OWNER C�VAGENT DATE - � I ' �. <br />APPLICANT/FIRM REPRESENTED <br />ADDRFSS <br />HEREBY APPLIES FOR PERMISSION TO <br />I <br />ATTHEFOLLUWINGLOCATION �'�_�� i`���ci�S�Y� <br />�� _TELEPHONE - <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show ihe follewing as applicable: <br />' Property lines and street identity. <br />" Outline and dimensions of existing and <br />propused structures. <br />t Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />* Topograpnic changes requiring cuts and fills <br />other than normal foundation. <br />* f`r.-site drainage systems when required. <br />* Erosion control methods when required. <br />* North arro�a� <br />_ �'i i�; <br />Signature of Applicant <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />, . . . . . . •j ��[.r N'i' rr �/ e.,�_ . i iG.'1 - ,J!°/ Hn � F <br />. . . �(L/CIs . . �,l,u.. � ! <br />.. / � G �ra r,� �, <br />. . . ._.. ..C�i(./S�'LN . �> I!'7P. .S:f�..iP/ . <br />/�'C�LINTFC�' . <br />� <br />_JiI� �F GI✓f'� <br />.....t.. . ...d. .. . .... ... ........... ... ....... <br />; . , �: . . i ..: , . . . . . . . .. . . . . . , . i . . . , . . � . . . . � . . . . <br />......;....� .._.-.y—�. . _ . . . . . . . . . . . <br />� . _ . _ . . . " . ' ' " ' ; .. , .._..... ... .. . . � . .. � . _ . . . . <br />. , . .. , . . � . . . . . . . . . . . . . . 1 . . . . . . . <br />j .. ' . ..__.I . . ' ! . . -� . . . . . . . . . . . . <br />. .... I . � , . � I <br />T- .� .__ .� _ , _._._ . ♦ . r. <br />. . i { � . . �. . . . . .� . I� .' . . . . . . . . . � ....... . _ . . _ ... ..- . �.. , <br />. . : . . . � . . .. . I ' ..i � . . . � . . . . . . . . � , . . . . . . � . . . , , ' . : . . . . <br />. . I. .�. . . ... <br />, . . .._.__. _ i •-- r --.___.j .._._' _� i_+___ _._ _ . . _ M _ . . .. _ <br />.... � -F t. ..... <br />... �.._�..�.�..: ... _�. <br />, �,.... -t. ...; <br />�-------� � , . <br />. ...._..____t��_ ._.__._._�_____�.. <br />� . � � . . . . . . . . , � i . . . . . . . . . . , The undersignetl owner hereby agrees to hold antl save harmless <br />. . . . . . . . . . . . . . . . . . . <br />. . .__.....� . . . .,Gla�.� i;,.-. . <br />-^" / x <br />�/-r�"�/ �-^� ,% i�y�'.��'�7.�"J <br />�APPROVED FOR CONS CTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />Ihe Ciry ol Everetl trom an> ana al1 clalms for dameges, cosis, <br />expenses, or causes ot action Ihat may arise bacause of installetion <br />and mainlenance ol the Improvemenl or other righhol-wav usa <br />hereto applied for antl Iurlher egrees to remove seme upon notice <br />�rom Ihe City and to replace Gublic property damegetl ihereby. <br />CONDITIONS <br />— �' �� <br />POS7 OP! I� CALL FOR INSPECTION <br />JOiBSITE �59•8811 <br />24 HRS. BEFORECONSTRUCTION <br />'1 <br />1 <br />� <br />