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� <br />r <br />L <br />� <br />�everett qppLICATION FOR PUBLIC WORKS PERIiAIT <br />TYPe or Prinl clearlY with ink I <br />PRESS HARD - YOU ARE MAKING COPIES ` <br />PUBUC WORKS PERMIT NO. }� �'- _, <br />EVEFETT, WASHINGTON BLDG. DEPT. NO. G�_ <br />`�1.DWNER ❑ AGENT DATE � - �Z — <br />7 � <br />APPLICANT/FIRM REPRESENTED �.� . � xzc...+ _i�,_ - T <br />ADDRESS �n . t"��r,�C I1�- CITY �U�2w� <br />TELEPHONE �� `�/�`% <br />HEREBY AFPLIES FOR PERMISSION TO _ G�^--�-rz�; �_--r 24 y�F,v ��,[� tir,�{ <br />AT THE FOLLOWING LOCATION %?�i_ f`�.71 � ti� 5 i r_ �� n� n-rT �•% <br />Attach five (5) copies of prelirninary plans for proposed work Draw to scale and show the following as applicable: <br />" Property lines and street identity. * Topographic changes requiring cuts and fills <br />* Outline and dimen,ions of existing and ot�ier than normal foundation. <br />proposed structures. t On-site drainage systems when required. <br />* Existing and proposed utilities. * Erosion nt I ods when required. <br />' Centerline of abutting right of way. �*�NQrth a row � �' <br />� \ <br />� . <br />Si neNre of pp icant <br />PUl�LIC V✓ORKS PERMIT <br />, <br />CONDITIONS: , <br />--_ ___ __ _.._. _ __ . . . _ <br />� ...... ......... .. <br />I� � . �. ���'� �o.%� � o•: �� io.. cf�. :��sa �c�r.ve.,.,��..1 �.�-.{�.,.� .-1�nr i-?.bli�� �r:,��.•'�-�.-o.�-. <br />i. 44tt�I s�i1f. �t `�[:J[��Y . . . . . . . . . . . . . . . . .. . . . . . . . . . . . <br />I 1 ` \ L <br />.1 <br />l_... . . uZ�_ ��-ot , c1U�v,n-c�Y.n,�rt�1 .2/.i� �O_ bC . -IIr1I✓�'Iv�.? �i <br />_ l <br />� . . . . . . . �Ju�r. '.( •-'CC"....__. _... . _ . .. . . . . . . . . . . . . . . . . . . <br />,� . � 3. .<xy�.'?'��uc. . ,�...',-<r�l�r.� � G...��c�c r< l�-�.7�,.i <br />;_ _... b< <:r;,,�.,��� ,� 1��: �.���;� ���::.�� <br />j : : : : sa�:�:�1 ;� . :;:-.-�. L <br />�. <br />�, ../_ _ �:.. _. __., ._:_.::.:.: <br />� . y �n. . .kK-'P/lrc ..��. �fi'C�.Y^- � �vr. '�ICw" . <br />i. . _ . �. 1 . . . . � � <br />_..__.._.. .. u��l.M�:1.c,y._ �{tc:i.� I.�..c. .�o.n-�-n;11rJ. iti r... . <br />i . . . . . .dlF-a . , . . <br />/i�h/•c� ��✓ur.�-S.��y''?c.-�/n�rti.1--� . <br />i. . . . . . . . . . . . . . . . . . . . . . . . . . <br />h `.�v <br />C1 ...� �' c•. f . . <br />. . . _ . . ,1 . . <br />� q � . `��n«, l � . <br />��; ,a. �_J . . : <br />�1�: rv. ., ��,�.<( �%a.-.;, . _ . <br />rv�s\�\nYl. .T���:Il�i�:l.�L�. �/. <br />� � ' � ' • � � • � � � � � - � � � � . . . . . . 7he undersigned owne� hereby agrees to hold end seve harmless <br />� ' ' ' ' ' � • � � � � - � � � � � � � � � � � � Ihe City ol Everelt trom any antl eu claims �or tlemages, costs, <br />� - � ' ' " " ' ' � ' � ' � � � - � � � � • � expenses, or ceuses ol action that may atlse because ol instellation <br />� � � � ' � � � � � � - � ' � " � ' � ' � ' � ' ' • � - ---�-- - antl maintenance ol ihe improvement or o�her righ4ohway use <br />� . � � . , , � . . � � , � . ; � � � � - - - � ' hereto appiied lor and tutlher agrees to remove same upon notice <br />� � � � trom the City and to replace public property tlameged Ihereby. <br />� - l_'-�,i� --- � S,•t� > _ <br />� APPRO�F R CONSTRUCTION DATE ACKNOWL M 'l�OF._.C.QNDITIONS <br />1 7 <br />APPROVED AS CONSTRUC D ( J Z 3 �z <br />UATE �51GN URE F APPLICANT DAT <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION y'�5� �� <br />POST ON � CALL FOR INSPECTION <br />259-8811 <br />JOBSITE � 24 HRS. BEFORE CONSTRUCTION <br />C <br />L <br />� <br />C <br />