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r --' <br /> ---- ---- ------ <br /> r------- ----- -- -- �. <br /> I il <br /> �Ie"e`e" ' APPLI��. i ION FOR PUBLI�C WI. r�KS PEI�IIAIT � <br /> � TYPe or Print cleadY wi�h ink � i <br /> li FRESS HARD-YOU ARE MAKING COPIE: pERMIT N0. j <br /> I PUBLIC WORKS <br /> '� EVERETT,W.��SHINGTON BLDG. DEPT. N0.�3�/ISS� , <br /> I iY.OWNER ❑ AGENT DATE '����--� ' <br /> _ '� i <br /> �. � � <br /> I APPLICANT/FIRM REPRESENTED �'�� �i.4n��• � 'I, <br /> 4 -` r� - ��-^ �A/ <br /> I � ��r�rP`L� TELEPHONE �-i / � I <br /> � ADDRESS � � �� ��� �1,T�=—� � CITY <br /> � � <br /> � � ."'-t-: .. _ .,e � ,e_t t'-i ( i7'n - �, � � <br /> I HEREBY APPLIES FOR PERMISSION TO C-_��.��--- � <br /> / 0 <br /> ��i <br /> � � . � � �, r,.Py'� �)�''1 n � ' <br /> � ✓ t� <br /> AT THE FOLLOWING LOCATION _�ct i' � I <br /> I Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the tollowing as applicable: i <br /> � * Property lines and street identity. * Topographic changes requiring cuts and fills I <br /> � * Outline and dimensions of existing and other than normal foundation. <br /> I proposed structures. ' On-site drainage systems when required. i <br /> � * Existing and proposed utilities. ` Erosion control methods when required. <br /> � " Centerline of abutting right of way. ' Morth arrow <br /> I <br /> � �y�-�r C " ��n.ie. �, <br /> � SlqnaWre of Applicant <br /> PUBLIC WORKS F�ERMIT <br /> I CONDITIONS: ' 1� � �, <br /> � <br /> � . . , �.� /� 1 ��/ <br /> 'I , ` / � ,� ��f , <br /> ._:_,_i�:_. � , . . J� '/ . � �� B, � ,� <br /> I �, .i ' ' . . . b. . . _ "I . . . � /t � � AL IP . . . . �� . . . . . � <br /> � : '', � j � � . . 1l� , � � i� / �V U� \y '', <br /> I . ' ,._ . ; . . . + ( Y, � j r� ,� P�^' � <br /> i Q '� <br /> � <br /> . : : _: j ; : '�.� . �( � � Q � �!� _ . . . . : . � <br /> �� r � 5 I <br /> ���� 1 �� ' _ . : �. . �.� � �'�� ���'� ��� '� �, �� � � � I <br /> �— � - : � � , �� �o � <br /> � , . . : : . : : � � <br /> f . . . � . . i <br /> L� - --- '- �- " � � Tne nnaeru�fl�ed owner hereby agre^s to �old antl save harmless <br /> I `` � � . � � �� � / i of Everett tmm any and aii cleims lor dama4es. cosls, li <br /> � I, � . . .� . � . . . . / Ihe C ty ..,. <br /> I ¢xpenses,or causes ol aclion that may arise because ol Instellation <br /> end mainlenance of ihe impmvemanl or other rigM-ol�way use I <br /> I � � - : � � ' ' ' ' � hereto apPlied br antl IurtOor eB�ees lo remove seme u0on nolice : <br /> � , Imm the City and to replace publlc pmpeAy damaped ihe�eby. <br /> r <br /> �I ;� . �'1_� j �I <br /> i „ ACKNOWLEDGEMENT OF CONDITIONS <br /> PPROVED FOR CONSTFUCJON DATE <br /> �ii SIGNATUREOFAPPLICANT DAT � <br /> APPRUVED AS CONSTRUCTED DATE <br /> � CALL FOR INSPtCTION <br /> PERIIAIT IS VALID FOR 1 YES�R pOST OPd 259-8811 <br /> �' JpBSITE 24HRS. BEFORECONSTRUCTIOM ; <br /> I� EXPIRATION _ . <br /> J <br /> .J <br />