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r-- <br /> � <br /> I "'�`�" ' APPLICATION FOR PUBLIC WORKS PERMIT <br /> II � TYPe or Ddnt cleadY with Ink Z/ <br /> i PRESS HARD-YOU ARE MAKING COPIES pERM1T NO. � <br /> I pUBLIC WORKS BLDG. DEPT. NO.�9� <br /> EVERETT,WASHINGTON /Q a/ 8 - <br /> I �OWNER ❑ AGENT DATE I <br /> i � ��2..1 Q <br /> � APPLICANT/FIRM REPRESENTED • �^�� �� � .� a�-(�y9S <br /> "3'�� fg ' ��}D �) b.\��_CITY G�lYI'�—TELEPHONE <br /> ADDRESS <br /> � <br /> Q i � � GAgA4� off ActEy <br /> II HEREBY APPLIES FOR PERMISSION TO U � � ✓ <br /> � <br /> IATTHEFOLLOWINGLOCATION 3�-�8 NOr{p� I�U� EVeh�-'H' WR • <br /> IAttach five(5)copies of preliminary plans for proposed work Draw to scale and show the follow;ng as applicable: <br /> � • Property Iines and street identity. •Topographic changes requiring cuts and filla <br /> other than normal foundation. <br /> I • Outline and dimensions of existing and . an-site drai�age systems when required. <br /> I proposed structures. +� Er sion control methods when required. <br /> � Existing and proposed utilities. . No�,arrow <br /> • Centerline of ebutting right of way. � <br /> � k <br /> i� p e o� icent <br /> '� PUBLIC WORKS PERMIT <br /> : CONDITIONS; _ . - . . <br /> ��I i . ; , _ .. _ ' . . . ;. . . . . . . . . . : . ' , <br /> i : . . r � . : j . . • ; • • : : � � � . . , . . � �� . . . 1 . <br /> , � . . . 1 . _ . : { � : � _�:�_ __- - - - -- - . . -- �---� -�, . . : <br /> �' .~ 'Y . . ', : . , : : ' .�' 4 � . �_ ' _: _ ->t_" . . : l . ` : j : : , . . <br /> ; . � � s 1 . . • � ; , . . <br /> ; _.� - 1 - } . _: 4 _ '` ; . ` . . . . f ' : t . : . � + : • ; ; <br /> ; . . 1 . . . . . . . . { i . ; . , . . . . <br /> ! � �� . . , .��:� . . , ` ' -r- �_—��_.-.-t_ � . <br /> i — ` �� � , . . l T � • . <br /> �t � . . : I . . � r �, � t � <br /> '� " , : 4 . � . i ' . . 1 . . � , . � � . . � � : . ' . . . ; . . . { ; • : . � � ' . � . . <br /> , . . . <br /> � <br /> . . . : . . . i . . li • � ._.(_-• • ' -- •-' _ �_. . . . . . - . - � ' . '. � . I <br /> � . . . . . .J ,f . �� � . . �_. . � . . ;. , , <br /> I � . i � <br /> � � � � � ---^a— ' -'-��'� � The undersigned owner �ereby egrees to�old end asve �armleae <br /> ___i_..--_..�.» . . . . . . . � <br /> _ ! .f � � � � � ' • ' ! the Ciry o1 Everett trom eny ena au cialme lor damaqe0. cosla <br /> , , : ` : : : �i � � � ; � ' ' ' � � � . � � ezpenses,or causes oi actlon Ihat mey edse beceuae W Inatdletlon <br /> � � and maintenance of the improvemant or othe� d9hPo4wey uee <br /> � ---� • - --- • � � � � - � � - � � . , . . � � hereto apPlied for and further aBreen to remove aame upon�uUce <br /> I ` ` . � . . . . . . . . . <br /> irom the Gity antl to replace puhlic D�oPeNY dam�ped �hareby. <br /> �� G <br /> � DAT ACKNOWLEDGEMENT OF CONDITIONS <br /> �I D OR NSTRUCTION � , � <br /> ' � � / f2 � �L¢.�1� <br /> « �•�– ���,, RE OF APPLICANT DATE � <br /> I APPROVED AS CONST CTED DA E I <br /> � CpLL FOR INSPECTION <br /> � PERMIT IS VALID FOR 1 YEAR ppST ON 259-8811 � <br /> ' JOBSITE 24 HRS.BEFORE CONSTRUCTION I <br /> �'� EXPIRATION _ - <br />