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� <br /> _ <br /> � _ -- ...�— - -- --- _ , <br /> II "'"�" APPLICATION FOR PUBUC WORKS PERMIT <br /> �I � TYVe or Ptlnt cleady wllh Ink <br /> �I PRESS HARD•YOU ARE MAKING COP�ES pERMIT NO. $�2 Z � <br /> � PUBLIC WORKS ' <br /> I EVERETT,WASHINGTON — BLDG. DEPT. NO. <br /> ❑ OWNER ❑ ACENT DATE <br /> APPLICANT/FIRM REPRESENTED ,` i�'�� <br /> ADDRESS � � 70S �'��/� S �' CITY Ls1t��Gy-,L="-'-TELEPHONE .�`�4-59 BZ <br /> HEREBY APPUES FOR PERMISSION TO �� � � + � ����\� l 'Ort � exceec� l00 C•y, ) <br /> J <br /> � u 5 � �S%' @ a o3 eQs�- � o <br /> � � <br /> AT THE FOLLOWING LOCATION a Z O 3 L o S�" ��'^ m <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as appliceble: M <br /> � � <br /> • Property lines and street identity. * Topographic changes requiring cuts and filis <br /> N 2 <br /> • Outline and dimensions of existing and other than normal foundation. m <br /> proposed structures. ` On-site drainage systems when required. <br /> ' Erosio control methods when required. "o <br /> • Existing and proposed utilities. o � <br /> • Centerline of abutting right of way. ` No arr /� <br /> 2 —ZI <br /> ! m <br /> - � � nature of APplicaN � r. <br /> �__- .O Z <br /> PUBLIC WORKS PERMIT �_ <br /> .. � <br /> -, �, <br /> < <br /> CONDITIONS: " <br /> i . . . . . � n <br /> I . . . . d/ J'. tt � -i m <br /> . j,: : . �ill . is � c�rF. e o 0. slo �e �,o �- � " �, <br /> : : : : : c�cee� 1 '�z .� 1 G� � cesee�S.� �1 � r,o� <br /> o r <br /> c-�m <br /> ^ N <br /> _ _ . . . . . .-�. 5e�-�' � N <br /> 1 Z � <br /> � (�� --� r <br /> i \ ( � fr / 1� 1 �e CP 0.�r�r�/. . . . . <br /> '� • m <br /> ; . . .°�' . .. .�N � �C2FtG�C .O'c_ �.>'�S-�ryµ� �T . �o � . a <br /> ( r ( z <br /> � . . . . . . , � :� � �� SG�'1S� Gct �o.�: Od� �e � ��. S�.�j�ec1�0� � _ <br /> � a <br /> : : b . . . � <br /> � � � <br /> � ��� _ � � � <br /> �jc G��.��C: 13�� � �:�- � �, <br /> bL1 Z <br /> , � :�� ��:�� -t� � ��» . � � � <br /> ( � �� --}I- I� � <br /> I � I✓11.N,/��",. G./.QLl . _ . . m <br /> � . � �� . I The undersigned owne�hereby�9�t�hbld Ln`3 seve �ermleas <br /> � I'� � Ihe City of Everett trom any ana ali cleima for tlamaqes, coste, <br /> i � i� � expenses,or causes of action ihel may arise Decause ot inatelleHon <br /> G, antl maintenance of the improvemenl or other dBhFof-wey uee <br /> heretc applied lor antl luriher agrees to remove same upen notice <br /> Irom Ihe City antl to�replece public pro0erty demeqe0 iherehy. <br /> � :' " ���' �'/ % '7 <br /> ' PPROV D F�NSTRUCTION DATE �TiCI(NO��E�G�` E �a�CONDITIONS . <br /> � ��� Z- �, �o- - �� ,� -Z �'�/�� <br /> APPROVEDAS NSTR TED DATF_ �.StG AT F 7'�L AGT�JT DATE � <br /> � CALL FOR INSPECTION <br /> '� P�RMIT IS VALID FOR 1 YEAR pOST ON 259-8811 <br /> ' JOBSITE 24 HRS. BEFORECONSTRUCTION <br /> �� EXPIRATION— - <br /> r <br />