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everett nppLICATION FOR PUB�.IC WORKS PEREVIIT <br />� TYPe or print clearly wilh ink �,) <br />PRESS HAFf. � YOU ARE MAKING COPIES �� 3� <br />PUBLIC WORKS PERMIT NO. �`� <br />EVERETT, WASHINGTON �^ z�� BLDG. DEPT. NO.$��OFf�3_j <br />❑ OWNER i�AGENT DATE _____ <br />. <br />APPLICANT/FIRM REPRESENTED ___ �/7�_�rl�CG-(�� ��1'V� _ _ ��lY��/_ <br />^V� ' / <br />ADDRESS ���' � 27C� `'� CITY �`�-�fl , _TELEPHONE r� i_ �� �. � <br />HEREBY APPLIES FOR PERMISSION TO _ S�G- � X( S��Cq ��41/i 4,\ )�, _il <br />ATTHE FOLLOWING LOCATION <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 />propased structures. <br />' Existing and proposed utilities. <br />" Centerline of abutting right of way. <br />CONDITIdNS: <br />!i~ ,��U _i- ���� .1 I . <br />i <br />' Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• Gn•site drainage systems when required. <br />' Erosion cQ'ntrol methods when requir,e, d� <br />` North arrolv l � // , i <br />— ' -� L' , � n , <br />i9nalure o ApPI <br />RKS PERMIT <br />. . . . _.... _,. .. . . . ' ._.... � t..._+a_ . <br />. . i , T. �__..._. <br />�, 1 � � �� C <br />,_ • ' ' � � � ' , ' <br />� ' � I . { � � I ..I � � �._p � <br />! <br />�. 1-,-� - � _, � . E .. ,1 <br />�r'r ����p , �` <br />.._. ... . . � :.r <br />4. � � <br />' $ .i. � � � <br />� ...i 1 ..._. t I . <br />t ' <br />� <br />.-r-�.... � , _ �_„ _ .. _ .. -E�-+ ' . _ _ i _ .. _ _i__ _ � � _ -�C <br />� ' = � - , -, -, , ;_ � `_..f : <br />�. <br />�. y � �.. .. , � �- + ' -' ! � � ' _ � � <br />� � � <br />�1 _ i � I , ; � � i . <br />� � 1 � � -I <br />I i i � �, f..� , �; _ .�._ � .__;— t <br />. � � [.: <br />}. ��,_,Gi ,. � �: ' -.. "1 <br />... <br />� , � , , ; . � � r � <br />�. __� i ; . . . <br />, <br />� f; � �-h__� _ }_ _' i __ . .. . : . '. . i_._ . . ._ � ` . . <br />i <br />� ' ..: ' " �' ' , t- - - i � <br />. _.... �... � .� ..., , . . ..... ... .. . :._. . .: .. . . . . . , . . . _.' �� •. <br />PERMIT IS o/ALID <br />EXPIRATION <br />'= �� 3 '�" Z-- <br />/ DATE `//L /� <br />� y <br />The untlersi9ned owner here�y a9rees to hold and save �armless <br />Ihe City ol Everelt Irom any ana all claim5 br damage5, costs, <br />expenses, or causes ol action ihat may arise becauso ol inslallalion <br />and maintenance ol Ihe improvement or other righ4ol-wny use <br />hereto applied lor and lurther agrees to ramove same upon notice <br />hom �he Ci1y antl lo replate public pro0erty tlamagetl thereby. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />DATE SIGNATUREOFAPPLICANT DATE <br />1 YE�1R ppST ON CALL �OR INSPECTION <br />259-8811 <br />JADSITE 24 HRS. BEFORECONSTRIJGTION <br />, <br />