|
�
<br /> I ��" APPLICATION FOR PUBLIC WORKS PERMI
<br /> TYce or print cieariv wit�ink T
<br /> PRESS HARD•YOU ARE MqKING COPIES
<br /> PUBLIC WORKS PERMIT NO. $ '� 3 p 9
<br />� EVERETT,WqSHINGTON
<br /> ff�OWNER ❑ qGENT DATE _�2_�/__�j L _ BLDG. DEPT. NO.�_
<br /> APPLICANT/FIRM REPRESENTED A� n �
<br /> —�--��L_C^o��=T.
<br /> ADDqESS �. I 3 7- H//L ,�� � �
<br /> -�-�—CITY Cvf�l_ p� Tr _TELEPHONE zs_ 1-7y�
<br /> HEREBY qppLIES FOR PERMISSION TO PAUF `
<br /> DRivc� L9� � 212( F/aST
<br /> G .��
<br /> i
<br /> ATTHE FOLLOWING LOCATION � Z �p ��} j r !
<br /> �t��..�n ,
<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. � Topographic changes requirinp cuts end fills
<br /> ' Outline and dimensions of existing and
<br /> proposed structures. ather than normal foundatfon.
<br /> • Existing and proposed utilities. ' On-site drainage systems when required.
<br /> ' Centerline of abutting right of way. � Erosion control methods when required. �
<br /> North arrow ii
<br /> �s.n� 7"' /7'�i / ��
<br /> con,n�r�ows: PUBLIC WORKS PERMITtureolApplic�n� ---- ;}
<br /> SFF R 7-T �cN MEi✓ ; ,
<br /> � � +" � ."1_�I F i...f I -�_ `��'I_ . `-•-• t '.-� .�.�...���,�� '
<br /> --. ..;._� � _�, � �� ..: ' -i� �t ' i'.;.. �_� LI �.r�.�I r � � i_� �..i._'_ ! I 1 �_a J 1 l .'� � 1 i .:' .. 'f
<br /> � � � -r-I + ' ; j-�-�_; '�_�-;� '-`�-�(�` ;. ,_j-� , ��:_. � � ;. T!�_-- '-_'.� .V;�! ` � 1 �_ . �::: 3
<br /> � ; � �_� _ ,
<br /> :_ �.. i 1 t � r � . � � ;
<br /> { �� ' r +�r L� � � � ' � t -`-�-J --if �� ' ., , � � I , , � I _ l � : :
<br /> _ , � i , .� jr -�.�{ i_
<br /> � � � L , "'r-'--I-'- i r � i , � __ , , _ � i -{ � � , �
<br /> -�1� , ` r� � + � ....� 1 1, 1 � � -i- � � t y � � �7'� T� � l.j � a t f_7 i � .L 1 .� , � �
<br /> : t �_( � � ,� � I 1"_� L '-.� _�--�. L i ��� ` � ,� ` _� j I . j i�
<br /> ((( �� f � � i_ � ; _- � � � ( `i- � �... .
<br /> j � '`i � �� � __1_ � I
<br /> � I � .�.1-� � ' � ;�.? ; I i .E � 1 � ._� �t !...t 1 i � '-,'— � � � i-. 1-.�. r,.t� t�_�i_:��}_. �
<br /> �_,- � ` 1 1 1 �1-7 � i �_i .� : � � i
<br /> t--rrr. : � _t I- r ' � .1 ( ,� � � i_ � � i t.. , ( � � 1 � r- , .
<br /> , �� �_�.. , r 'f }
<br /> i ..l-l�l t-� ��it� �T -•-_ # I :�J' ' �._i ,-a-._�-. � �- "� � I'1I � r � '�'�I.... � � I i I � �.. �...+
<br /> � �' '_
<br /> � { 1 .- t �.Li� 1 ' .�._�I I 1"'� � � .,.._� _ i t _. .. . 1 . . .. j
<br /> 1
<br /> -� .
<br /> ~ - �_..�_�_ . .
<br /> � ; � , � � 11a-... �
<br /> f-; { 1.. .w...�..,_1___L_..;.T�� + � _.
<br /> � �� �. _ . . : �
<br /> : �
<br /> i � ', r'�` , � ' . � The untlersigned owner hereby aprees to �pld an0 nava harmleu
<br /> . � Ihe City ol Everett trom eny enp eu cwma lor tl�m�0a�, co�ts,
<br /> Bxpenses,or Ceusas ol aClion thet may efiee OeGu�e of In�hllatbn
<br /> ,. i�., and meintenance of t�e Improvemenl or otAar rlp��.p�.w�y use
<br /> ' �� / / herelo applie0 lor and lurihet epreee IO fefnOv!yTs uppp�p��
<br /> {�� from ihe City gptl lo replace
<br /> �- publfc properry Gm�p� fhsro�y.
<br /> '� P OVED FO ONSTRUCTION � Z
<br /> �AT ACKNOWLEDGEMENT OF CONDITIONS
<br /> AP OVED S CO� � ED . ,arE� / �
<br /> -�-- -�-��-�.rz.. ���� ZQ- g�
<br /> PERMIT IS VALI�-FOR 1 YEAR GNATUREOFqppLICANT DATE
<br /> POST ON CALL FOR INSPECTION
<br /> j_ EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION
<br /> �
<br /> �,
<br /> � -
<br />
|