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► <br />e` ��' APPLICATION FOR PUBLIC WORKS PERMIT <br />.� � . . <br />Type or print cleady wil� Ink ' I <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO S� �` `' � <br />PUBLIC WORKS <br />EVERETT, WASHINGTON i � ;. i . ` <br />1?]�OWNER ❑ AGENT DATE � , --- ` <br />\ , <br />r. <br />APPLICANT/FIRM REPRESENTED —.—..� �'--_�:'—"— <br />/ ` 1 , ` <br />ADDRESS � � � � ''�-'—" � � —r— <br />i HEREBY APPLIES FOR PERMISSION TO _��"� <br />, . `l . . _ _ . ., / <br />ATTHE FOLLOWING LOCATION � � � i:� <br />BLDG. DEPT. <br />�•��-tr..i,'�,1� TELEPHONE -��� � — 7� 3Ci ' <br />iVs�S� : �(_-�-�--5.� i-� ,�., r.'� <br />. / <br />' Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />n <br />' Property lines and street identity. <br />• Outline and dimensions of existing and <br />proposed structures. <br />' Existing and proposed utilities. <br />t Centerline of abutting right of way. <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 />* North arrow <br />,, ;; <br />— rSignature of APPlicant <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />., `. ` ao' st.abF�k; -�:w, <br />. : . . . . 1. Lu r `��r �': v:nvi �i vvica�•, i �+,.., <br />. . . . . . �(U f')E�rT�y, ' Iv� C .. �(Cl�P('� 'i.i i: 1S .Q�:)?roX.�vi��<<� <br />1 I , <br />. : : , , � : �. . � � �-��C�" . hC��ncJ 'ti�E. Cx�S���„ ��,c�r;�,�.a 1.�. . . . . . . <br />I <br />:. . � . . i . , . . . . . . . . . . . . . . . . <br />. • . '`� . . , . . . . . ; . . � . . . . . � . . . . . . _ . . . . . . . . <br />.-. ..� . . . . . . . . . i . . . . . . . . . . . . . . . . . . <br />_.,1 � .. . . � _ .-__ �i � _. . . . . . .. _ . . _•_ ' ' _ . . ... .. . . . . . . . . . . .'__ . <br />�. � . . . . . . . . . . . . . . . . . . <br />. . . , . .i . ' . . .. �. . . . . . . . . , . . . . . . . . . . . . . . <br />y____—. . �_._ ! ._ � ..- .... . . . . . . . . . . . . . . . . . . . . . . � • _ . <br />. . . . . � . . . J. , . . � . . . " <br />. . - . . . ��� �. . . . <br />L--. -- h b a rees to holA antl sa�e harmless <br />PERMIT IS <br />EXPIRATION <br />The untlersigned owner ere y g <br />ihe Cily ol Everelt hom any ana aV clalms lor damapes, costs, <br />e�penses, or causes ol oction Inat may arise because ol installellon <br />... and mainlenance ol Ine improvement or other tlghPobway use <br />. hereto applied for and lurlher ogrees lo remove seme upon nolice <br />Imm the City and to replaco puDlic propetly damaged ihereby. <br />-� ; _ {� L. <br />',e v <br />.ID FOR 1 YEAR <br />j_,� .z._8� <br />C� <br />ACKNOWLEDGEMENT OF CONDITIONS . <br />� � <br />� ,' . ;� .. I� . , ,�/•,. � - ����!�. i <br />SIG�t ATURBOFAPPLICANT DATE � <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTIQN <br />Q <br />