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°"""` APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYDa or orint cleeriv witn Ink <br />PRESS HARD • YOU ARE MAKING COPIES C/ <br />PERMIT NO. b <br />PUBLIC WORKS <br />EVERETf, WA�HINGTON ,�� /�-� BLDG. DEPT. NO. <br />❑ OVJNER �r.C�GENT DATE _ � s�f� �� f ' <br />APPLICANT/PIRM REPRESENTED — <br />ADDRESS <br />HEREBY APPLIES FQR <br />ATTHE FOLLOWING LOCATION <br />TO <br />7 <br />TELEPHONE� � <br />t U C� rza�� �i ,� �• <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 />proposed structures. <br />' Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />Q��3 <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On•site drainage systems whsn required. <br />• Erosion control methods when required. <br />a AI..d6 a......, <br />IT <br />CONDITIONS; _ _ . _ ___ _ - <br />�. <br />, . /: �� f- �Q !d-. o-Y c�'n q . • ,� . �,! <br />I: ..-: a{ O io.n I �.ifwn (r•� u� <�N6/� <br />f.,,i. dc ;FJt'vt�! / <br />l . ; l � . �r�usl-- <br />�/�v::.:: <br />i.......,. . . <br />.�:.�^.�.}--- ... . . . .. . . . . . . . . . . . . . . . . . . . .. ._.._._. ._. _. . _._._,__ .__._ _. . . <br />. I ., _. _..� � . . .:.. _ � . . ~ <br />�� I � : : f ;-; : _ : : ._: . �. . : : ` . . : . . ! . _ I : . __. . . . <br />.� � <br />� :; ;i::. :::�:i::: jy j :.:.: ;::.�':.:::'� ::; <br />_ �:_: �", : __ � _; .:..._:__. � . . . . :�� � . , . . . . . . : � � . . . . . <br />__,_ __.,___7 ,-�.a—._,____. <br />:: � ::;:::t:::�::. ::' 1. :.�:..� : } ::i:, i .: <br />I _ � } .._:� �. ._' ,� �_ r t. _� _.--. 4 �... � . _ _ : � . . , . . . . . . . : . . . . <br />� . . , , . . i . . . � . . . ��__�_.�._��. . <br />r__��T___-}_._ __ � -- <br />l. . . . . .-:-t---- . � . . � . . . . . <br />. . � � i . . . . . . . . . . . . . • . . i � . . <br />'� . . . . . . . 1 . . . . . . . <br />� % i�P�'��.,.�'� y-�y-�3 <br />A PROVED F R CO TRC��— DATE <br />� � _F�-�3 <br />PROVED AS COMS7RULTED OATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />The undersipnetl ownar here6y aBrees to hold entl save hermlass <br />the City ol Everell trom eny ena all cleims for damepes, Coats, <br />erpenses, or causes ol ection ihel mey arise beceuee al Inetalietion <br />and malntenance ol the improvement or ather righFol-way use <br />hereto �pplied lor and luriher egroes to remove e9me upon notice <br />Irom the City end to replacu public property demaped thereby. <br />ACKNOW�DGE ENT OF ONDITIONS � <br />�i` <br />L_� /��� ' /`, l � l% <br />SIGNF U E OF APPLICAt�T DATE <br />CALLFORINSPECTION <br />POST ON 25g.gg� 1 <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />