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^ <br /> "'�'�" APPLICATIa�N FOR PUBLIC WORKS PERMIT <br /> Type or pNnt cls�rly wll�Ink <br /> PRESS HARD•YOU ARE MAKING COPIES pERM1T NO. �, � <br /> PUBLIC WORKS �' / <br /> EVERETT,WASWINGTON � . � � <br /> BLDG.DEPT. NO��J / /�� <br /> ❑ OWNER �AGENT DATE � <br /> / h/,c_ C`Q.vrTr'u C:��1/ / N � • <br /> APPLICANi/FIRM REPRESENTED ��E��If�- n <br /> D �/ u/ / ZG CITYScD.I-� /��L�EL HONE I� S��- S�OD� <br /> ADDRESS Z� �� <br /> HEREBY APPLIES FOR PERMISSION TO <br /> 8���o A �'fl,�f16C-�" <br /> � ' " ; ! .. . Cv :r<L<.: , <br /> AT THE FOLLOWING LOCATION �O L 3 �-��'�N� � �� �✓�GF i� <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br /> • Property �ines and street identiry. '7opographic changes requiring cuts and fills <br /> • Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. " On-site drainage systems when required. <br /> ' Existing and proposed utilities. • Erosion control methods when required. <br /> • Cente�line of abutting right of way. ' NoRh a�rro�t��--r9"—� "�"���, Q <br /> �G� % ,��..:;rti% //`cS <br /> �" SIO�ature of Aa7����� <br /> PUBLIC WORKS PERMIT <br /> QONDITIONS: . _ _ . <br /> I . . r . , . . . . ' . , . ' I . . �I <br /> I : : . , . : : I : : . . ���.:�_ : : � : ..�__-:_-.-�-�-_�,' -_:� : : : �,»�`�: : <br /> �i.�_ � � —___�__. j . , . � - ."; . , . . . <br /> -� _' } � � ; <br /> _ _._�� _ . . . : . � : _ -' : . : <br /> � , . . . . . I - - � - � ! •-- , � ' Z <br /> _. _ .�� _,. , . � � � . . . . . <br /> ', . . : � 1 . . . . ' . . . <br /> � . . . . . � � . : : . : : ._� . . _ ._. . . . . _ . . . . . . . . . . . : . :.. : . '_--,-----t-- <br /> i <br /> ---- � . . . � . . . . . . , <br /> � �. ' : i �. : � �� : : : . : : . . � <br /> : - . . ; - �-�j-- .--�-- j � L.%� C� <br /> . . , : . . : , � , <br /> _....�-�-----}------;--'--'i-' � The unCersiqnetl awnar hereby aqmas to hold��d ure�armleea <br /> j . � ! - l • � • h,���'i�',,���Y� �-�;)�' ; � � � t�e City ol Everell trom eny ana an cuimn ror A�m�9s4 cost�. <br /> r . . . 1 : . ; { : � � ' � � � . eapenees,or cauxs of ectbn lhet mq adee bec�use ol I�utNl�tbo <br /> � 1 ' ' '�+��.�� ��`- ���'�j��"'� � antl mainlenence ol Ihe Improvemenl or d�er rip�tol-w�y use <br /> ..._- .-..._..�::.i.,c. � -_�_.r"..«..- - <br /> � - �-•-'-' . hereto ap011etl lor and lurther eqroee to remove uma upon notka <br /> '. . . . . . . . . . . . . . . . � . .. . iram Iha CItY end lo reDl�ce Public DropeM am�Ob I�sreby. <br /> � . . . . . . . � '.'�. i - . . . <br /> / � � / ACKNOWLEDG F OND I NS <br /> AP ROVED FOR�C TION � �:�"!- Z <br /> NATUREOFAPPLICANT E <br /> APPROVED AS CONSTRUCTED DATE GpLL FOR INSPECTI N <br /> PERMIT IS VALID FOR 1 YEAR ppST ON 259•8811 <br /> � ��_ �Z JOBSITE q4HRS.BEFORECONSTRUCTION <br /> EXPI RATI ON-. <br />