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w APPLICATION FOR PUBLIC WORKS PERMIT <br />PU� WORKS <br />EVERETT, WASHINGTUN <br />O OWNER ❑ AGERT <br />APPLICANT/FIRM RE <br />ADDRESS <br />Type or D�int clearly wilh ink �( <br />PRESS HARO - YOU ARE MAKING COPIES pERMIT NO. SL� ��I <br />C� BLDG. DEP':. NO. ����� <br />: <br />DATE�D_� �/ ' ��^� / <br />:NTED _�.E � `� /" Y;�' 1�~/C. <br />--_ -- -- - - <br />� ? <br />�u��j� >e v ' ` )^ CITY �v`�'�`- --- TELEPHONE✓J�� -23 `� ( <br />HEREBY APPLIES FOR PERMISSION TO �% ��S�Yuc' � �(��� �i L' �� y���� / N <br />/v o/L/e/r/� �G � ��7' v o .r�/. — � _ _ <br />ATTHE FOLLOWING LOCATION <br />� <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 />CONDITIONS: <br />� <br />� ��- <br />I <br />i ' ...� <br />i <br />' . �.� <br />�--;—� r � <br />; ._ i <br />La ' � <br />i l I I <br />� . l l �- . <br />;1_ t ,' <br />�:.:_I_ r1- <br />—� <br />�� � <br />, <br />� <br />, ; a�.. <br />� '__:. l_ <br />PUBLI <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-site drainage systems when required. <br />' Erosion control methods when required. <br />.G�� `��� /� <br />_ �/�i<-�-� <br />>. ...___...___�.__�"_ _. _ <br />PERMIT <br />�;._ . � � � , � � 1 ' {-- - :_ . <br />� i .. i , ' i <br />4 x 1 I` '— ��—� 1— <br />—}— � i }(� i i <br />1� ���Y� i� � -�- � � t 1 � I .� I .��.' � .. ..�. � � . ' f_ <br />,. � <br />7 L-:-1-5• �. �_�-.-�1.-� (�y �^' _� .J. i '._ <br />� I I_ � <br />l . I;'_� � i _ � f � ' . _ � <br />� � ; , . �. <br />! 1i_ ��« �— �i- -.: � — <br />- , ,�� <br />�� f 1'_, �� - � , ...� ,_i j .. � <br />i.'. .� . �.�.. ' .. � . . . .... _ �i. _.. <br />. � ,_ � i ' 1__ l 1 l ; .!. , � , i ' , ' r _� __ , . <br />' -;--�- � -1 {--- ' -- --- � - <br />,— <br />� � , , <br />,,, ._. , _: .. ; �-: <br />,, , , , , <br />, . ; _ <br />� , ;;. ; . . <br />, . �` : : �� � ; �_'� <br />_ , � --. ... <br />; - ' � , I ' , <br />_ , _. <br />�. ,.. <br />�� <br />���/n�y� %/_�-�2." <br />cc -. <br />- � APPROVED FOR NSTRUCTION DATE <br />' c <br />�. ��- c'�.'l.s•ti/�.G j� � 0 3 <br />APPR— O� D CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />The undersigned owner �ereby agrees to �old and sava hermtess <br />�he Ci�y ol Everett vom any ena au claims br dameqe0. cost0. <br />expenses. or causes ol action �hat may arise because ol Inatell�tlon <br />antl maintanance ol ��e improvement or ot�er riqht•of•way uee <br />he�elo applied br and lunhor egrees to remove same upon notice <br />Irom thc City antl lo replace public property demepad t�ereUy. <br />ACK LE EMEN ONDITIO <br />' , �� ��f �3 <br />SI--�Fy-YI_�� DATE <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />