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, <br /> � . <br /> '� <br /> � <br /> � <br /> r - - _ ---� <br /> �everelt APPLICATION FOR PUBLIC WORKS �E�iMll' <br /> TYVe or Prinl cleadY wllh ink <br /> PRESS HARD•YOU ARE MAKING COPIES pERMIT NO. _�`-'' /��__ <br /> PUBLIC WORKS v <br /> EVERETf,WASHINGTON BI.DG. DEPT. NO. 03 � d� <br /> r �OWNER ❑ AG[NT DATE �,� � <br /> APPLICANT/FIRM REPRESENTED �'�/ C�GI�_L�o.�� )_l�9 I�„�� <br /> 6 �/J - // � - - G <br /> ADDRESS L�Q/ ��__���� - CITY ��l/(i1GuTELEPHONE <br /> HEREBY APPLIES FOA PERMISSION TO —G�G.�.(G--�fl�'�1��� .��.��J <br /> AT THE FOLLOWING LOCATION f�� y f,��/ � <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and shovi the following as applicable: <br /> ' Property lines and street identity. `Topographic changes requiring cuts and fills <br /> ' Oulline 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 /> 'Centerline ot abutting right of way. ' No h arrow <br /> � SiQnatw ol A00 ent <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: . <br /> I . . . . „ <br /> . . �ti��y <br /> , , <br /> :-: - G� ,r'i�i�.- . �«.c'� .�X i � s i��� <br /> ; . . . . . . . . <br /> ' . . . . . �� /i✓J'jf9�G. S' SI.,�r�Jsq,<�- /�.�' S,�s ..��'H t`J�, 7 <br /> i_ . _. _ . . . . . . . . . . . . . <br /> 1 <br /> � . : . . . �J �v�2 /7JAic,a?>Xc'l' ��f�.vb ,S,<n_r2�l�C/i- <br /> . . . -�i\ . ��c�Y�' 'S'iG n� /��.C_ S i.C7 :s/� `,��=/1i�'!<i Sh�/�.i/�j� <br /> _ ..� � . F!<.�: ��J . /`�f�.�'itilJ-C 5��.9LC S _ �'_;l c�i �'r� . . . \ <br /> i . . . . <br /> ! : : . /-'�:� : , sr:� i�/ f� '�� -;i. <br /> : � --: : : : ; . . _ . <br /> . . . . . . . i . <br /> , ._. . . . . � . <br /> ; _ ._._._. .___,___----., .�,-.__ _- . <br /> , , , , , . . , � , . . . . .�� � . Tnc unAr�s�p�ed ownar here�y aqrees lo�old and save �armless <br /> . . . . . . . : . . . . . . . . . . . . . . . . I:in Cny al Everett trom any ana au Uaims ror tlamapee, coat4 <br /> . . . . . . . . . . . . . . . . . . . . . e�Censes,or causea o�ecllon Ihnt mey arise beCauae ol Inetalletlon <br /> � - � • • � � � • � - � � � � � � � � � ----- • � � � and ma�ntanance ol Ihe improvement or olner riqh4ol-wry we <br /> . � � � � � � � � � � � � � � � � hereto auD��etl lor and furt�er agreee to remove aame upon nallce <br /> ' ' Y � � ' Irom ��e Cily anA b reolar.n pu6lic p�operc� CamapeE I�ereDy. <br /> -�/ �� __Y���. —-�"� <br /> L E CONSTRU TION (D`AT�n ACK�JOWLE�GEfdENTOFCONDITIONS � <br /> i `/ I//J�} . / � �/'�'1 <br /> / � L / `(� /�, �CL � � �`�I �. . / ;���i ."F l <br /> AP ED S CONST G D DATE SIGNATIIFE Cf AP�LICANT `� � DATE <br /> PERMIT IS VAL FOR 1 YEAR pOST ON CALL FOR INSPECTION <br /> 259•8811 <br /> EXPIRATION JOBSITE 24 HRS. BEFQRF�GivsTRUCTION <br /> L — - <br /> r <br /> � <br /> � <br /> I � <br /> J <br />