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. <br />- � APPLICATION �O�R PUBLIC WORKS PERMIT <br />� 7ype or print Ge�dY wHh ink _ <br />PRESS HAHD - YOU ARE MAKING COPIES pERM1T NO. <br />PUBLIC WORKS BLDG. DEPT. NO. <br />EVERETT, WASHINGTON i_ _ /�L <br />'�OWNER ❑ AGENT DATE —��� <br />� f� % ! v�L <br />APPLICANT/FIRM REPRESENTED -- ���– � h� � l T <br />01` SJ�'�o�SO(� //!A/✓/-� CITY Fv�!"'�=TELEPHONE ,�5� -J�_�/ <br />ADDRESS ' <br />OP /.�%.c�%'C "/lUi�" FY ci.f��'n� <br />HEREBY APPLIES FOR PERMISSION TO rNT 1- <br />/�/GG li�f' ��?S � <br />l <br />,- c-��'/ asaG Gi.r'`rr�o ,a-v c� y�� � <br />AT THE FOLLOWING LOCATION n� � <br />Attach five (5) copies of preliminarY plans for prn�osed work. Draw to scale a�d show the following as applicable: <br />• property lines and street identity. <br />• Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Cente�line of abutting right of way. <br />" Topographic changes requiring cuts and filla <br />other than normal foundatfon. <br />� On-site drai�age sYstems when required. <br />� Erosion control methods when required. <br />• North arrow <br />,CONDITIONS; _ _ _ . . - _ _ Bc-TwGEp GURB AUD <br />�.I... ..MArk... W'.DTN OF S�DG�A�K 19 �i� <br />. . . . . . . Ph-iLALI.GLL wRl.1L,. . . <br />..��' .NO,, .. Ll�4HT11�.4 �. APPURTL-A1AWG�S v-�1�..�-. .6E . %►�.I.OWED L,AsT'�oF <br />I . � h� :Tri� . t-zi.snu6 � �IDEuJA�K; AiaY 1..lE,Hri1JG F��tETURC-S . . <br />� li�STn�-�GD W�'f dF 'i'HC 61D�rUALK -SHA��- SG- N�►� <br />. <br />._._._. ._. _ . _ . . . . . . . -o FI�oD LAMpS. , . , <br />piRcc�iv►�AL � N . . . <br />..: ..: .:_: . : :_:.:. .. ; - ._. <br />._ _ :i.. .. <br />,. . . <br />.. , . <br />,� �: � .:� .; ��. :: .... - .. <br />� <br />. � : . , , . �: _ . . _ _. . . . <br />�...,.. .; _, ...'... , , <br />• ' ' ' ' ' �� � � � � .^ � � � � . ' —� ! ' -' � ' hereby a0rees to hold and eave harmless <br />. f . <br />��—.—}--� � 4 , � . . . . . <br />� <br />::�:}-.:.��'.:'.:�: �:.�:�.1�::.. <br />1.�--. . .._ 1 .. . . . . . . . . . . . . _ . . . . <br />�I . . � . . . . . . . . . . . . . . . . . . � <br />; . . j� , , . . . � � , <br />� /'�/ � <br />4� p- ACKNOWLEDGEMENTOFCONDITIONS <br />// �O O � - . �. . / .. ,;Y�v . I <br />Af-� . <br />A SIGNATURE OF APPUCANT � DATE � <br />R CALL FOR INSPECTION '�, <br />POST ON 2591-8811 ; <br />JOBSITE 24HRS.BEFORECONSTRUCTION _ <br />PERMlT IS VALID FOR 1 YEA <br />EXPIRATtON ---- <br />The unders�gned owner <br />the City of Everett trom any ana en cialme lor Gmape0. coet0. <br />ezpenaea or ceusee of actlon ihat mey arlee bec�use ot �nsiellatlon <br />and mainlenence ol tha improvement or ot�er riphlrol•w�Y uee <br />hereto apP��ed lor and furlher egreec to remove s�me upon notice <br />Irom lhe City and to reD�ace public property Oamepad thereby. <br />R <br />