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everett APPLICA710N FOR PUBLIC WORKS PERMlT!� <br /> � TYCe or Print cleaAY wiih ink L7� �� / <br /> PRESS HARD•YOU ARE MAKING COPIES pE'iMIT NO.• — <br /> PUBLIC WORKS � .. <br /> EVERETT,WASHINGTON Q,-, BLDG. DEPT. NO. _ <br /> . <br /> I$OWNER ❑ AGENT DATE �L___'r� '' ~ <br /> APPLICANT/FIRM REPRESENTED —��L_`=� w—''f R Z IVC �c R _ . _ _ _. <br /> ADDRESS I� �3 �' ��.y� CITY fk'�ri� TELEPHONE %�% �- � � ��5�' <br /> c.�.yrs�_�, v� -- -��_r_�e_ r, �„� <br /> HEREBY APPLIES POR PERMISSION TO —t��� <br /> ��1'�-,fi -� .� .. .�fi �, ,��� P S' Pr�� ��r�% :�.,�.c M.� .�� F���-��_ <br /> � ^ - <br /> 7o P��G� � '� I K `'n��Ll <br /> AT THE FOLLOWING LOCATION ��-�-��-+�=— - <br /> Attach tive(5)copies of prelimfnary nlans for proposed work. Dra�v to scale and show the tollowing as applicable: <br /> * Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other than normal foundation. <br /> proposed struct�res. ' On-site drainage systems when required. <br /> • Existing and proposed utilities. ' Erosion control methods when required. <br /> ' Centerline of abutting right of way. ' North arrow <br /> � <br /> w ,� .�- �;� <br /> �i��`� � iLT/ �' -- <br /> Signaturo ol Apolicant <br /> coNoiTioNs: PUBLIC VIIORKS PERMlT <br /> `\ /� ,, <br /> (J �r�G'L' +'�C! �U !��'Or�' f/C�/2 7`� �) ,f�l� <br /> / / <br /> ' . _ i�'�� f�� !�-z_ �'�� �a c'�^� 7`�„s-,-� 2s� fi j � . <br /> �1 �;. 1z� n �j, C ��� <br /> l <br /> , <br /> I 'i i� � f <br /> �-,'�; � � ._. <br /> i , -, '_j � - <br /> . ; . <br /> -� �-,._ <br /> The unde�s�gne0 rner hereby ag�ecs Ir holtl and, ve �armless <br /> Ihc Ci1y ol Everi.l Irom any ana au cinima for demepes, cosis, <br /> ¢xpenses.or causes ol action tha�mey arise bocauee ol inntallallon <br /> end maintonance ol I�e �mOwvement or olher tlphPo4way uee <br /> hereto aOP�iod lor antl�urther egreen 10 remove same upon notice <br /> Irom Ihe City and lo repiace Oublic property demaped Iharaby. <br /> / � ��� <br /> pp��...i � � �G'�' _ <br /> OR CONSTRUCTION DA,E ACKNOWLEDGEMENT OF CONUITIONS -� <br /> ,�J_ �7 r <br /> �A l�� N�,�C��—f-�'���-�/� r1/7 ��U W ' e5��-�^^�+�c <br /> 'JL <br /> A PROVE AS CONSTR DATE GNATURE OFAPPLICANT DATE <br /> PERMIT IS VAL{D FOR 1 YEAR CALL FOR INSPE C T I O N <br /> POST ON 259-8811 <br /> JOBSITE 24HfiS. BEFORECOMSTRUCTION <br /> EXPIRATION <br />