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� <br />r <br />L <br />.. <br />. .. .-. .....++n.�< ..1 .ea!nYr � .�Nkrr.-. ` .. <br />everett App��CqTION FOR PUBLIC WORKS <br />� TYOe or t�rint clearlY with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETi,WASHINGTON 11/29/82 <br />❑ OWNER ❑ AGENT DATE .._ _ ---- <br />George W. Osborne <br />APPLICANT/F�RM REPRESENTED <br />510 Madison <br />ADORESS <br />PERMIT <br />PERMIT NO. ��/3� � <br />82/11282 <br />BLDG. DEPT. NO. <br />Everett 353-8498 <br />TELEPHONE <br />Construct addition to existing residence <br />HEREBY APPLIES FOR PERMISSION TO <br />510 A47i�SC%X�X Madison <br />ATTHE FOLLOWING LOCATIGN <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. <br />' Outline and dimensions of existing and <br />proposed structures. <br />` Existing and proposed utilities. <br />• Centerline cf abutting right of way. <br />CONDITIONS: <br />� <br />* Topographic changes requiring cuts and fills <br />other than normal toundation. <br />' On-site drainage systems when required. <br />w Erosion control methods whan required. <br />• North arrow <br />PERM <br />SignaNre ol ApplicaN . _ <br />Ex�s4i� S�dewe.lk a.• n 1�•,•,ew`..'y <br />�Yn.� ��n.,.c�u.w.uqrc'. a�—�.ne c-r' / <br />��r....-4- Rqp�....� . � <br />PERMIT IS VA <br />EXPIRATION <br />,.. . <br />- �E>: r ,. �- � � <br />. �` <br />The ��ndersignetl owner hereby agrees Io hold antl 5ave harml85s <br />�he Cily of Everett Irom any antl all ciaims lor damages, cosis. <br />expenses, or causes ol aclion ihat may arise because ot installalion <br />and mainlenance ol ihe improvoment or other right�ol�way use <br />hereto ap0�ied lor and lurther agrees to remove same upon no�ice <br />Imm the Ciry and to replace Oublic proparty damaged thereby. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />//, � o ,�=a�-t'�-,. ' i � z� S'_ <br />SIGNATURE F APPLICANT DATE <br />1 AR CALL FQR INSF'ECTlON <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUC710N <br />n <br />. ,� . <br />.:,� <br />, ,: ,fa, . . � ._. <br />i <br />r <br />