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-` <br /> e"e`e" APPUCATION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Prinl clearlY wilh ink <br /> PRESS HARD-YOU ARE MAKING COPIES r- <br /> PERMIT NO. �'/ - 7 .>� <br /> I PUBLIC WORKS <br /> EVERETT,WASHINGTON c^./� � ` BLDG. DEPT. NO. �� <br /> I �i[OWNER � AGENT DATE r �—_ <br /> II APPLICANT/FIRM REPRESENTED —_—�C-_���J � K �� //�c7�_ <br /> ADDRESS ���� N o r� C7 n CITY �_TELEPHONE � � /�� <br /> HEREBY APPLIES FOR PERMISSION TO � �' ° G ` <br /> I <br /> n r � ;� � � <br /> I AT THE FOLLOWING LOCATION ( � r/1 < ✓' (' C�' Nr�y c <� �(' �((J.q d �J7i7� :Yo. �r. ,. <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 (ills <br /> ' Outline and dimensions o( 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. ' Nort arrow • <br /> ��J �� <br /> .Lt' ^ � ���.C,I�CQ.,-✓ <br /> , ` � �Signature ol Applicent <br /> � PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> i ; � . 1 �1 J <br /> . . . .�. V'll cl�.�� G.�v� - a VP�I' iF'��o .�. S"�f.(J RIo.�` G� w..L� f'NC o.a� � rn S 1�. <br /> d � 1� � , <br /> ', . . . . . . . . . $� .�. 1 J� . w� �+ 0.c Q.S GfOS� ur CA.+�o � <br /> �I i�\ . . . . . a.• �a�� mHw� AIIUwG�l e OP.i �1'S nP+ v�n �-.,' c�a �� �C <br /> � ( <br /> � ', � a�. . . . . . . . �.5 �. .yc�S �a�pro�,. ( J -�rNcl< � �a�s). ��y -���-4,e. ,,,,���1� . <br /> i ' . . w�ll rPS�„K� -�µr +�.e.. �la� � a� � c�e !i� s — �s � ��- a s / <br /> .� . . . . . . . .. . ero S�.o h . Go,n ��o.� . ��A� 5��"o�o .iny't�,�nrl�'e n� G.� pivPns i�j.L'�f-c. <br /> �J �� �~.. .. . . . : . . . ' . � P <br /> 1 �+ ���^,s. _ . � ^ .�� � <br /> ,�� L.���- �7� �'i ' � � <br /> '�, ; : 3 , �� P� <br /> .� � _ �ur <br /> ; l� L ctoSL, i I <br /> f _ � �' CD �j 5't�iZ , CTl � � <br /> fThe undersi�neC owncr hereUy agrecs lo hold antl save harm less <br /> . Ihe Cdy ol Everell tmm any ano au claims lor demeges, costs, <br /> � , . . . expense�,or ceu:es ol nction ihal may arise because ol installution <br /> � _ . .. . . . . . . . . . . . . and maintenance ol Ihe imp�ovement or other �ight�o4way use <br /> ' . ; . . . . . . . . . , herelo epplied lor and lur�her cgrees to remove seme upon nolico <br /> � . . _ _l . �J! � � � � - -�^ iwm the Cily and to rePlace pu�lic property damaged Ihero�y. <br /> i�- ' 1 ' � <br /> � � '� 1.� . � ___-- � e � <br /> ' APP V�f R � N R IION DA ACKNO LEDGENENT OF CONDITIO S , ; � - <br /> i .. / L' � � <br /> I 3 z ° i ,�� �. -�r��.� yL9��, <br /> � APPROVED AS CON RUCTE DATE SI NATUR FAPPVCANT DATE � <br /> PERMIT IS VALID R 1 YEAR pOST ON CAL� FOR INSPECTION <br /> - /.. !,:� � 259-88i -' <br /> , EXPIRATION— '� '�' '�--' JOBSITE 24 HRS. BEFORE(' .�UCTION <br />