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I everett / ° 1 . , -- -- — -- — <br />i � APPLICATION FOR PIIBLIC WORKS P�fiMIT <br />I Type o� print dearly with Ink <br />PRESS HAPD • YOU ARE MAKING COPIES <br />iPUBI.IC WORKS PERMIT NO. Z 2—C _ <br />EVERETT, WASHINGTON <br />i �y OWNER ❑ AGENT DATE � BLDG. DEPT. NO. _ <br />!"` �ljiiL .� O / /�_� <br />I APPLICANT/FIqM REPRESENTED ��/��_(,��'�7 „��(=___ <br />� L /I Kc -i?�ue ,U5 .— <br />IADDRESS �yE/3 !)I��'/S] j/�C" CITY ��l/L_µ TELEPHONE =% � _ �.S�L <br />HEREBY APPLIES FOR PERMISSION TO � 7it_Uri ��U .ii ,' y _ <br />S O ,U U/. <br />A�s <br />ATTHE FOLLOWING LOCATICN �1P� D/,�/r S'j" <br />Attach (ive (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />I ` Property lines and street identity. <br />� * Outline and dimensions of existing and <br />proposed structures. <br />; " Existing and proposed utilities. <br />I • Centeriine of abutting right of way. <br />PUBLI <br />CONDITIONS: <br />: �. 1-h..� rU�-� ,�„ �( �t��: <br />I::.::..: : , <br />..,:��,a a4 .;�.,. _I ;�,. .F- <br />..:��...;. <br />i--- } -- . . <br />:� ;•�:i...... ' \// <br />-. '.-+ j .---�-. ._. i__. . . . I Y <br />: _. ; � : . . � . _ C�,,v . <br />�:::::~�,:�: �. \ti� <br />��::::_ � 1� <br />...... � <br />_.�-�-� = ,��� <br />"__ '. % � . // /. <br />DA <br />' Topographic changes requiring cuts and fiils <br />other than normal foundation. <br />' On-site drainage systems when required. <br />* Erosion control methods when required. <br />' North arrow <br />0 <br />�ORKS PERMIT <br />�I�,��.�a��, �.,:�1i.�.. <br />�. ,��, . <br />," <br />S'CZ <br />�u� <br />The untlersigned owner hereby agrees to hold and seve harmlass �i <br />Ihe Ciry ot Everelt irom any ana an cieims for damape0. cwts, , <br />ezpenses, or causes ol action Ihat mey arisa because ol Inatallelion i <br />and maintenanco oi ihe improvement or other rl0ht•of-way use <br />herelo applietl lor and lutlher agrees to remave eame upon nollce � <br />imm tha City antl lo roplace public propefty tlameqed thereby. � <br />I <br />; <br />ACKNOWLEDGEMENT OF CONDITIOIJS � <br />.�- / � <br />�.�T � _1�-.��_i �-'�. /. 7i_.. c- , � <br />PERMIT IS VALID FOR 1 YEAR <br />POST ON <br />EXPIRATION--1 �S- �-3 JOBSITE <br />CALL FOR INSPECTION <br />259-8811 � <br />24HRS.BEFORECONSTRUCTION I <br />_ . . ---- -- -- _ - --- �� <br />R <br />� <br />� <br />