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"'°'�" pppLICATION FOR PUBLIC WORKS PERMIT <br />� TYDe or Print clearly with ink <br />PRESS HARD • YOU AfiE MAKING COPIES pERM1T NO. � 3 3 <br />PUBLIC WORKS <br />EVERETT,WASHINGTON BLDG.DEPT.N . ��� <br />1�OWNER �AGENT DATE I� ��-�-�-- <br />APPUCANT/FIRM REPRESENTED Sr�__��- -�-�-- n���--- --- <br />ADORESS 'tS\ S��NO �V �- CITY C��`-'�� TELEPHONE 2SZ-�S <br />HEREBY APPLIES FOR PERMISSION TO F��YAT�" ��� ��`'��—`X= ��N�/iTIC�►� <br />ATTHE FOLLOWING LOCATION —�� 5 ��'��� ��� <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. <br />' Outline and dimensions of existing and <br />propose�i structures. <br />• Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />,...t <br />�--� -. , <br />� <br />�L <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-site drainage systems when req�'red. <br />• Erosion control methods when requfred. <br />' North arrow , 7 „/') <br />IT <br />� I '... I � . ' � . . F . <br />T � � '... . 1 .. , �� � . i <br />f . _ � � <br />t �'_.4. 1�. �- �.�.. . �. . . � j ,_ I 1 . i l ' � 'f.. . <br />. <br />� 1 i . �... .L.: � ..'-. i i � ._._ . �. — . . -i -- <br />�. � �T I � ' � ! _. i .. . - � ! <br />� i ,.� 4_ , t. .. . i � � T , � _, .. . I .. � , �_ i -. . <br />� . ? ; � ; i __ `--' ' ..: '. i !-1 � <br />�_ � <br />� � � ' ; . ' , : I "- . � ; . � <br />f..�rt� . l � <br />t � 4 � ;.��I_. � t . � . �.. . _ . : i r 1 I <br />r - 4, L <br />; �r1r -7�+ - Y �t�T ' <br />.. ,_ .. __ , �. _.. • <br />:; '' T�_ • .. � r- <br />. _ . i_ � <br />, , <br />, . . . , ;_ . I 1 1 1 <br />. , 1 <br />o ., <br />, � , . _, . , . � <br />PERMIT IS <br />EXPIRATION <br />FOR 1 YEAR <br />Thc undc�signed owner hereby agreos to hold and seve �armlena <br />the City ol Everell Irom :.�y ana an clalms lor demepe4 cost4 <br />expenses, or causes ol action thal may wr�se Decause of IneUlletlOn <br />and maintenence of ihe improvemen'. or other riphtohway use <br />�B�elo applled br and lurther ngrees lo remove e�me upon n011Ce <br />Irom ihe C�ty and �o rep�ace public proparty demepeO �heroDy. <br />fE ACKNOWLEDGEMENT OF CONDITIONS <br />`l <br />7i i — 11 � <br />fE SIGN URE��F LICA DAT <br />CALL FOR INSPEGTIvn <br />POST ON 259-8811 <br />JOBSITE 24,HRS. BEFORECONSTRUCTION <br />m, <br />� <br />J <br />