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� <br /> , -i <br /> i <br /> � <br /> everen AP'PLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPo or print clearlY with ink <br /> PRESS HARD-YOU ARE MAKING COPIES <br /> PERMIT NO. `�a <br /> PUBLIC WORKS <br /> EVERETT,WASHI TON BLDG. DEPT. NO.�s���� <br /> I— ❑ OWNER AGENT DATE 7/��_ <br /> APPLICANT/FIRM REPRESENTED �G�fz�e�G��r'ISQ S _ <br /> ADDRESS ��'��•�,.�� �av c'•3� S��te 1oS�ITY � e TELEPHONE�a�S�'- <br /> HEREBYAPPLIESFORPERMISSIONTO �)�c� flkis'�� ho ALI F4 'FOr [��C�c�SC 7� ) Gq�^a�,e <br /> ATTHEFOLLOWINGLOCATION I� � c�ak� RVF_, �ue�^e 1 1 �v. Qc�J��l <br /> Attach five(5)copies of preliminary pians 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 sy§tems when required. <br /> ' Existing and proposed utilities. ' Erosion control methods when required. <br /> * Centerline of abutting right of way. ' N rth arrow <br /> _ ��.�.v�,..� c--1- c�� <br /> �9' nature of Applicant <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> � � <br /> � <br /> i i <br /> � I I <br /> � I 1 � � I <br /> � � � I I � <br /> ' � � I � <br /> � � I <br /> � � I <br /> � � � I � � <br /> � I I I � <br /> � I � <br /> � � <br /> - _ � I <br /> 1 _ �_ f i � <br /> � � - � - <br /> � <br /> � I I I I <br /> � _ I i � � <br /> r r� � <br /> - � , - <br /> _ _ ; <br /> i i . l--:--1 � <br /> _ �-�- "r-r- � } �1_'1_,_t -1 <br /> � <br /> � <br /> f �--+-.. - _ ;..1. The undersigneA owner hereby agrees to hold end save �armless <br /> Ihe �ity ol Everett trom any ana ail cleims lor Eemaqe0. costs. <br /> - �t- exp•snsea or ceusas ol ection thet mey arise bacauee ol Inetalletlon <br /> � � erd meintenance o� Ihe ImDrovement or ot�er riqhrol-way uee <br /> i � nereto epplied br and further agrees to remove aame upon notice <br /> from ihe Cl�y end to replace pu011c property demaped i�ere6y. <br /> � �7 �� �Z <br /> I P OVED FOR C NSTRUCTION _ T . K OWLEDGEMENT OF CONDITIONS — <br /> � �/�� � ` <br /> AP VEOAS ONSTRU 7ED � DATE SIG T OFAPPLIC DATE <br /> PERMIT IS VALI FO!i 1 YEAR pOST ON CALL FOR INSPECTION <br /> JOBSITE 259-8811 <br /> EXPIRATION _ 24HRS. BEFORECONSTRUCTION � <br /> � - <br />