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___ _ _ <br /> ----- <br /> ��F __._ — . . <br /> I <br /> ��, e•:.�rett1 ' qppLlCATION FOR Pl)BLIC WORKS RERMIT <br /> �,I �1 Type or print cloady wilh ink / <br /> � <br /> U pRESS HARD-YOU ARE MAKING COPIES pERMIT NO. x���— <br /> , <br /> PUBLIC WORKS BLDG. DEPT. N . <br /> �� EV�PFn.K�R�IIi�JGTUN � <br /> �OWNER O AGENT DATE 1U=I 3��_— <br /> APPLICANT/FIRM REPRESENTED S�� ���� <br /> CITY V� �� TELEPHONE 3 3 <br /> ADDRESS _� 6J—`a�r�CF-�S� 1-� . • ' ., <br /> HEREBY APPLIES FOR PERMISSION TO C�+ecK E{�U Sh� � � <br /> '��, �HAN B[ I ��� � <br /> I o T �e s�� E�E ET <br /> c <br /> �I AT THE FOLLOWING LOCATION . <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the(ollowing as applicable: <br /> I ' Property lines and streei identity. 'Topographic changes requiring cuts and tills <br /> other than normal foundation. <br /> • Outline and dimensions of existing and � On-site drainage systems when required. <br /> I proposed structures. R Erosion control methods when required. <br /> � • Existing and proposed utilities. • North arrow <br /> I • Centerline of abutting right o: way. <br /> � Signalura ul AP7���a � <br /> pUBLIC WORKS PERMIT <br /> �. <br /> CONDITIONS; L��� �p � p�oPGEzTY <br /> i I ,: MaxtMuM a2���waY w �b�-+ A <br /> i �l �E 5N ►�LL Ci� �� �' <br /> � .''D �-H A�— poct�t ON nF Tl-IE P�2��E W A,Y wl rN i�1 'T1-lE <br /> R���1� oF waY s�r��� 3� PA��D <br /> � <br /> I, , � . . �Z L� �3�DG c_o M PLETI-=1� . _ <br /> / <br /> i pp,� 9R\11� <br /> - .. . _ . �p u�.>c9 (C_� . <br /> : �: ; . . . . . .. . . . . . .. . . . . <br /> ' . . . . _ . : ` - ; <br /> . . � . � : <br /> • ' ' 1_,__�r,—_�-- The unde�si ned owner hereby aq�ees to hold and save harm�ess <br /> .- � A <br /> �'r��—' I � � ' the City of Everetl vom uny ana an ciaims lar demages. cosls, <br /> � � , , � - � � - ' ' expenses,or causes ol action Iha�may erise beceuse ol inslellation <br /> � ' ' � � � and ma�Nenance ol l�e imOrovamenl or ol�er ri9hto4wey use <br /> � �. � , � . . . . . � � ' ' � ' � � � � �omla aOPlied lor and furiher egreos lo�emove 6eme upon nolice <br /> , . . . / � � ' ' f' � � Imm �he City and �o replate publiC P�opahY dBmeBod Ihereby. <br /> UC 10 Ll TE �/ ACKNOWLEDGEMENT OF CONDITIONS . <br /> P OV �N / ` I <br /> ,Z� 3_$� \ l�� \\ `� - � � – A — <br /> DATE S�G AN OF A LICANT <br /> DATE <br /> IpP aoveonsco sr GTE� CqLL FOR iNSPECTION <br /> I, pERMIT IS VALID FQR 1 YEAR pOST ON 259•8811 <br /> � � � Z - JOBSITE �qHRS.BEFORECONSTRUCTION_ <br /> �i EXPIRATION -- -- - --- _ <br /> — --- — - <br />