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�-- -- -- --- --_ _ _ _ _ , <br /> \ I <br /> � �� � APPLICATION FOR PUBLIC WORKS PERMIT <br /> Type or print cleerly wit�Ink <br /> PRESS HARD•YOU ARE MAKING COPIES <br /> PUBUC WORKS PERMIT NO. i <br /> EVERETT,WASHINGTON �/ BLDG. DtPT. NO. �� 979/ <br /> ❑ OWNER ❑ AGENT DATE <br /> APPLICANT/FIRM REPRESENTED �rLrAf�QI�✓k C�O/�CS�T�U CT�/D�/ / it/C� • <br /> ADDRESS ZOB� �'"�W Y. ZO CITY-��� W""-TEL PE HONE DS�" �OO� <br /> HEREBY APPLIES FOR PERMISSION 70 �v�G/, A (v�J.QfJGG� <br /> �( ��/� c���oi I <br /> ATTHE FOLLOWING LOCATION �O Z,3 �,�,Q�t/�J _�(��, �"VEL�T� <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the following as�ipplicable: <br /> • Property Unes and street identity. • Topographic changes requiring cuts and fills <br /> ' Outli�e and dimensions of existing and other than normal foundation. � <br /> proposed structures. • On•site drainage systems when required. I <br /> ' Existing and proposed utilities. * Erosion control methods when requfred. i <br /> ` Centerline of abutting right of way. ' North arr� <br /> ���/-E-s I <br /> �� � Slpne�ureolApplicent ' ' <br /> PUBLIC WORKS PERMIT ' <br /> ; <br />,( CONDITIONS. . . . . . � - • __ - - ..; _ . . . . . . . . . . : . . . . . . • _ . . .� . . . : _. : I <br /> t ' _ __ . . � . . . . r . . � . � . . . . . . . . , . . . . . . . � . . . . . i . . . . . � <br /> � : : : : � : : : : : ' : " j : : : : . � . . . . . . . . . . , . . . . . . . 1 . . ; . , : . I <br /> �-�-� ' -�-- - � � -_��L� '___:_:_��_ ��_-- - � � �--- -:. : _.�_:_,_� :_�_, . ---}---- ` � -�.��; � <br /> � � � � � i <br /> : : : : : : : : : : : � � . : : : : � , . : : : � : ; : : . . . : : : : ; : : : : : : i � : : ; � : <br />; :.�. � _._:.�:. _ �_.__: . �: : : : : . . . _ : : ; : � � : : . fi = ' = : <br /> _ <br /> , , � ;�. <br /> ` . . : <br /> : . . . . . . . , ; . , <br /> . . _ . . . . . . . . . ` � . . . . . . <br /> � � <br /> �. � ' _ _�._ ... . .. . . . _.._ • __ --• - • . ! .. . _._ - -- . ._ __ +�_ ` __ <br /> -.-, . � . . . I � � � , � . , � . . <br />�1 1—.._ �-~-1~...�.� � �._:_. . ._ . . . .. . . . . � . . . . . . . -._ ♦_.-�. <br /> . r . . . � . . . . . . . . . . . . . . . <br /> , , ., ' � ~ ihe undersigned owner herehy agrees to holC and save hermleas I <br /> _ . . f : : : f , , . , . . , � . . . . . . the City ol Everett trom any anu au clalms lor Aamepe4 coat0. I <br /> ! I eapenses,or Ceuses ol action ihat mey ariae 6eceu.q ol Inits11a110n . <br />{ �� - .. - . - - : - . . . . . . . . ' --'- . . . . . and meintenance of tha ImDrovement or ot�er riqhbol-wey uae � <br />� • � � � � � � � � � � hareto eOPlletl lor and lurther agrees to remove aame upon notice � <br />� � . . . . . �,. . . <br />( �l f� � ��� � . � Irom the Ci�y anC Io replece public property demepetl �tleroby. I <br /> I �// f 1 i <br />� �� �`-��� ?/� l/ /'C� �/�Z/ /X� I <br />� P OVED R C N�J�IFN AT ACKNOWLEDGEMENT OF CONDITIONS � <br /> APP O D AS CONST CTED DA E � SIGNATURE OF APPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR ppST �N CALL FC1R INSPECTION <br /> 259-8811 <br /> EXPIRATION-1�-��- �Z JOBSITE 24HRS. BEFORECONSTRUCTION <br />