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�;; , <br />-- -- __ _�. <br />_—__ .- -- -� <br />I <br />�"""` APPLICATION FOR PUBLIG WORKS PERMIT <br />� TYPe or Prinl clearlY with ink <br />PRESS HARD - YOU ARE MAKING COPIES pERMIT NO. '�'� ���*�?--,� � <br />PUBLIC WORKS <br />EVERETT, WASHINGTOhJ BLDG. DEPT. NO. <br />f�OWNER ❑ AGENT DATE ��1.-LI _ � I <br />APPLICANT/FHiM�E�R�6EN�ia ��-� /"" <br />ADDRESS �q �� �U k� � ��—� �� d —��n �„� TELEPHONE � S�?�,7�p� <br />� w i .� <br />HEREBY APPLIES FOR PERMISSION TO � � �� `�' ��'-�-d-ei.��� �� � � �_ <br />AT TNE FOLLOWING LOCATION � �I I �.L �.�, ��.j��; �r �� L� � v� <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br />�' <br />P` <br />• Property lines and street idenfity. <br />• Outline a�d dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />* Centerline of abutting right of way. <br />BLIC WOR <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On-site drainage systems when required. <br />w Erosion control msthods whers required. <br />* No�th arrov+ _ <br />.ONDITIONS -- . . _� _+ __._ . <br />. . . /• � � �"A ra � nti/�'.� 'f-/'�,''"`' ��a- vt � S. u r � t e /. S � �n �eiz�r, Prl �". . . . <br />_.. . .._.. . ...y"!/1.tJ�/.�f.eU .QGIi . . . . . . . . . . . . <br />_. �. . . . . : � . ... . � . . � . . . . . . . . . . <br />� z) Dr���. ;�.�ry �s. : �� : :.1'w�rl� �"� f/ j. :su�ij��: o: �.�`1� . : ; <br />_._ _ , .. ... <br />� --�;c:3 t,i�q . /�!1 y/.�:'/7`�eo QL (/D /�� v�/1'1-e,� t �o �� � F/o cu S : . <br />� I�i�7r�-:/ :-�a?`e-r:ii �.✓`ii%`r.p : �l�/D. .�-oa�cult� ,('�r-f��S , <br />T .,__._. , / <br />_:.�:..;... <br />. _: 3} . . .r� uC : �c�� ,��.'iv�ri . �: : r�� f. f�or7{iu�- .a �'. fi�- - 9i�crcl�: : <br />� <br />-� i��ii���:; : /.�,� ;Y'��f�%f�o !��v� . i-�.s �'-a-E':w� i>��sf 6�e.: <br />_' ._._3�I ,;,�rov-/cL . ,6, : �'�-- �U��c �C.Jo�fJ 1ns ,v��r� �o <br />v . . . . � af' � uY� . . :_C'-0� >.c� >�sco /S. % 4�z- <br />� t�1 "—'�'1r -" "- ' The undersigned owner hereby agrees lo hold end seva harmless <br />i <br />�. j � � `qF� � ' � � � � � _ � _ , . the Ciry of Evarett trom any ana an claims for damagea coe s, <br />j' �� �� 1 ��' I expenses, or causes of ac�lon ihnt may arisa beceuse ol Ira�ellatlo� <br />' . <br />- ' f � ' n'�-� ,� � : �� , . .. . .. . . . . .. . . . and maintenance ol Ihe Improvemenl or other riph4ol•wey use <br />t rt, ., herelo applied lor and Nrther agrees to remove seme upon notice <br />. . .�. . (rom �he City and �o replece puhlic properly dameged lhereby. <br />. :;�. ��/i h f/��� . <br />ertu�unwi FDGEMdNT OF CONDIy�ONS <br />�_ <br />v i _i <br />PERMIT IS VALID FOR i YEAR CALL R INSPECTIO <br />POS7 N 259•8811 <br />EXPIRATION �v z� '�� �OBSITE 24HRS.BEFORECONSTRUCTION <br />