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(' everett APPLICATION FOR PW�LIc W�V�iK����ERMIT <br /> � TYGa or Print cleedY wllh�{^kO � �}�� <br /> PRESS HARU-YOU ARE M/�KING CdPlc � pEFMIT NO.�� '1 ?~` <br /> PUBLIC WORKS � - - - <br /> EVERETf,WASHINGTON � CITY OF C-VERETT BLDG. DEPT. NO. <br /> fi OWNER ❑ AGENT DATE _G,_"�A _���' L' Puh'i� �h'crl�ti D� <br /> APPLICANT/FIRM REPRESENTED - _�J����' `1 ` F-�.1��-------- <br /> � � �� V <br /> ADDRESS L..��/sl���� rt' �� ` '� CITY ��% � c %/ TELEPHONE -'� '� ;� :� <br /> HcREBY APPUES FOR PERMISSION TO -C-' t .s � r � i�- � <br /> ---- �' ' �� �!/ , f � - <br /> AT THE FOLLOWING LOCATION � � f' i r/c =� � ' ` �� "'' � / v �J' j <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. `Topographic changes requiring cuts and fills <br /> • Outline 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 of abutting right of way. ` North arrow <br /> , � i � <br /> /�-`.. .., � �S,-yt-: -c� <br /> , � � Si9nature ol ADDucxnt <br /> PUBLIG WORKS PERMIT <br /> CONDITIONS• i ! <br /> � -�,- i i � i <br /> � <br /> i i , � <br /> _ � ; <br /> - � � <br /> i � i � i � � � , � <br /> i � � � _ 1 <br /> , <br /> i - ; I �� - � '' <br /> i i � � � � , � <br /> i � i i i <br /> _ � � , , ; , <br /> i � i i � � � � i i <br /> � � � � ',�-, -!.-r-j_. - ' � ' � <br /> -:rt t <br /> � - �-- ;---}� i .- -i - �� . ,--i <br /> 'i i i_ �� .�- - - . . . <br /> - - �{' - � <br /> I <br /> i i � �_ <br /> _ '! -r_�i- _ <br /> _* I .� - -{...` - f_� � , . ,- ' <br /> i I I - � , � � _ � . � <br /> " I i --•--�-I I I <br /> 1 <br /> � ' I 1 ��. � � . � _. _ � !_ � _ <br /> •yT-' _/---.• -�- . . . . <br /> ; - � 1-`- � � - '� ____I - ----r--' ' -=-- - ' � <br /> % �-r� �- �_ <br /> i � <br /> I _�� � � � ' The under5igneA owner heroDy agrees lo ho10 antl save harmlass� <br /> f _ _ _ '�._. � Me City of Everelt Irom any antl au claims tor demeqe4 coats, <br /> � �, ' :-.�� eapenses,ar causas of action that may erise becauee ol Instaltation <br /> � � � end mainlenance ol t�a Improvemant or other riph4ohway uee <br /> � '� � 1 � hereto applied for antl lurther egrees to remove eame upon notice <br /> Irom tho Cily and �o replacc public Droperty ,femaged thereby. <br /> _� <br /> � i 'f—���L� <br /> PR VED FO�'C TRUCTION DATE ACKNO L UGEMEN�T�O�F CO/NOITIONS <br /> � , � I� ;,c� ,Zti�c•,_ �-� '�Z_ �j�i L� .-�i��� �c�� <br /> APP VE Y1 CONSTRUCTED � DATE t6�''FATUREOFTCPC�LI NT DATE <br /> PERMIT IS VALID OR'I�YEAR pOST ON CALL FOR INSPECTION <br /> 259-8811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION <br /> L � <br />