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f� <br />everett ��ppLlCA710N FOR Pt1BLIC WORKS F+ERMIT <br />� TYPe or Print cleedy with ink <br />PRESS HARD - YOU ARE MAKING COPIES pERM1T NO. —�'L "� •� <br />PUBLIC N�'�RKS BLDG. DEPT. NO. ��' �� 3'2 <br />EVERETT,WASHINGTON <br />� OWNER ❑ AGENT DATE �a �3 g S—� <br />Af-PLICANT/FIRM REPRESENTED f���'"%r ti E Tc�11( —__-- --- <br />���. l�vc.^�!7' TELEPHONE J-s1 '9 iSv^ <br />ADDRESS y�1 � �'Y� ��' <br />HEREBY APPLIES FOR PERMISSION TO _�" �` ���"S -- <br />AT THE FOLLOWING LOCATION � a 7 y°` r v. /= ✓U••-�T <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 of abutting right of way. <br />PUB� IC <br />CONDITIONS; _ . . <br />/ r �CC'���.i <br />. . . . . . . . ���� <br />�.::: <br />�.::_.�:��:.:::�:; ._: .__. <br />� :�� _�_ ;:: :_; :::: <br />,..:::: .:•�':: .::::�.:�.:. <br />__.,::_,. . �1;�;.;TMjJ 'T�-:-:� <br />---- -__ ; i - - -�--- � . . . <br />:::�:.���:}:::.� '. . <br />.. _,_. � r---- <br />:`�' : <br />, . <br />1 .. <br />. . . . . . . � . . . . . . . . <br />7 <br />��! !— c �/ ��Z ��S—.�`t <br />A�,�ROVED F CO UC�ON DATE <br />� � 3� �-�� <br />�_ % - y <br />� � n.;��`— <br />AP OVED AS CONSTRUCTED DATE <br />PE�iNlIT IS VALID FOR 1 YEAR <br />EXPIRATlON <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />� On-site drainage systems when required. <br />* Erosion control methods when reUuired. <br />' North alrow „ <br />�' ,-/�-� � � <br />PERM11 <br />� ,/J.cs/ --- /�r'<<.�S F.e�� . <br />/���y� ��' T <br />�vF�ii�i i r�..o <br />�� �-,�.vc <br />ln,.: un�Y•isiyneu �,�.��.� � I�•y�-0�� :ig�"�.•, Iv I:oltl anA save M1arml�•;s <br />the Ci�y ol Evera�t trom any ana aii Gaims lor dam2ges, cosls. <br />expenses or ceuses of action Ihat may arise 6ecausn ol instellation <br />and muintenenta ol �he imo�ovemant or other riQhl�of-way uso <br />heralo BO�lied lor antl luh�er egrens to remove seme upa� �O�ICo <br />Imm t0e Cily end lo replace public property dama7eA ihareby. <br />ACKNOW DGEMENT OF CO ITIONS <br />/� �f! � <br />1�.� � � <br />SIGNATUREOFAPPLI �HTE <br />POST ON <br />JOBSfTE <br />� <br />CALL FOR �rvsre�. � �v�• <br />259-8811 <br />24 HRS. BEFI)RE CONSTRUCTIOPI _ <br />'�1 <br />FJ <br />