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eV� APP�ICATION FOR PUBLIC WORK� PERMI�' <br />Type or print clearly wilh ink <br />PRESS HARD - YOU ARE MAKING COPIES FERMIT NO. �� � 3 � <br />PUBLIC WORK' <br />EVEFiE1T, WASHI�vGTON BLOG. DEPT. Nva � OSOD <br />❑ ON/NER ❑ AGENT DATE �%� Z- <br />APPLICANT/FIRM REPRESENTED �%�/.P /ycfl,e .T%/Tyy�,���y„��,� <br />, � <br />ADDRESS �� �` f�i,��i.5�'lL CI � ��-_� � _TELEPHONE .?5�3 -9z ya <br />HEREBY APPLIES FOR PERMISSlON TO <br />AT THE FOLLOWING LOCATION <br />Attach five (5) copies of preliminary plans for proposed <br />/ <br />and show the following as applicable: <br />* Property lines and straet identity. ' Topographic changes requiring cuts and filis <br />* Outline ar,d dimensions of existing and other than normal foundation. <br />proposed structures. ' On-site c+rainage systems when required. <br />* Existing and proposed utilities. ' Erosion control meiheds when required. <br />• Centerline of abutting right of way. * North arrow <br />� �� <br />s�%t:�l ' •)� <br />SiBnature ol Applicanl <br />PU�LIC WORKS PERMIT <br />CON.DITIONS: _ _ _ _ _ __ . _ __ . . <br />I...:..... <br />f� � ... � . . � O �.. «. ci t.�. t....� _o_1t . � x C��-i.�. J . .� r � v e.:.,., r. .I �c_� �-c. .� . . , .. . . . . . � <br />. ... r � 1 <br />� . . . � . . ' . . IS . .�sl��.v���`�. . . , :__. : . . . <br />i.: .. ... ;. .. ... ... . . . .� . . <br />i_.. _� . I . . . . . . . . . . . . . . . <br />.. � _ .___.. . . ._. _ .._ . __. ... . . ...�_ . _�_--. . _.___ <br />� � . '� , . . : . , . _ . _. _ `T ` - -! _. _. . <br />.r� .� . . � <br />. . <br />� . . � . � • _ � _... . _ � _ � . . : _ . " � . . . . . . _ . � . . <br />__ ,_,. _ , __ . <� : <br />i <br />,. <br />` i <br />� ��� .� �..�...�� _.' �'. � .��� ,- j�...j� . <br />f: . ; , a. E ... <br />i , <br />�.. _� � � .{ : , i . <br />i �,} ' 1.--�.;. j...: . . •._.i r '. ....i_. , <br />. <br />- : . , -- — <br />r �- r ,—i — _ _._ _ :__ _. _ _ _ . _ : _ _ . . . . . . . . . . . . . <br />,i .�: ,f.. , .. <br />� <br />I_:. .. .. f. .1 <br />. <br />,....,. ... <br />, . .,. <br />_ , , �;__: � _. <br />�____y_.______;__ --, ---- <br />� � � � . --j - � • � + � I . . . . . : � . . . . The undersigned owner here6y agrees lo hold entl save harmless <br />. � � ' ' ` ' ' t � ' � � � • � i � - � � � � � � - � the City ol Everetl bom any and au clalms lor demages, costs, <br />' � � � ' ' � ' ' � ' • � � � ' � � � � • � � � � � � expenses, or causes of ac�ion ihat may arise because of Inslallalion <br />' ' � ' ' " ��-' ' � � � ' �� ' ' • ` ` -- --- �� • �� � � � � � � antl maintenance of the improv�ment or o�her righFobway use <br />� � � � � � � � ' � � ' - ' � ' � � ' � - � - ' � hereto applied for and fur�hei a8�ees �o remove same upon notice <br />4 . <br />' ---� Irom the City and to repince public proporty tlamaged thereby. <br />_'�i�� �_i� �.� —�/.T�'�' �.�.. <br />i � � � <br />APPROVE AS CONSTR�C� <br />PERMlT IS VALID <br />'— EXPIRATION-- <br />1 YEAR <br />ACKNOWLEDGEMENT OF CONDITIONS <br />_.ia__ .� , n�..� O �D <br />POST QfV I CALL FOR INSPECTION <br />JOB�ITE 259-8811 <br />24 HRS. BEFORE CONSTRIdC"fIOM <br />a <br />C <br />� <br />� <br />� <br />��- <br />