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""`°" APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPa or print r,.eadY with ink f I <br /> PRESS HARD•YOU ARE MAKING COPIES pERMIT NO.��`�� <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON BLDG. DEPT. NO.S�— <br /> ❑ OWNER O AGENT DATE �/ � �3 <br /> APPLICANT/FIRM flEPRESENTED _SL_�-�Qx l..v�1 � �L --- -- <br /> ADDRESS �• � CITY LYNNGJ�roDTELEPHONE ?7�L �1155 <br /> HEREBY APPLIES FOR PERMISSION TO � K. �r�r l.�1L/C �J1�Lc.�S� IZvSuc.iT�1� <br /> ����r.Jo.�r�1Sr� �v�J� b <br /> ATTHE FOLLOWING LOCATION �O1S OA��rf /��V�.`'�L9�-�' �_VG-�4.`��_(N� � _ <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the following as applicaUle: <br /> ' Property lines and street iden'ity. * Topographic changes requiring cuts and fills <br /> • Outline and dimensions of existing and other an normal foundation. <br /> proposed structures. • On-sit rainage systems when required. <br /> ' Existing and proposed utilities. ' Eros' 'control methods when required. <br /> • Centerline of abutting right of way. ' No h rrn�v <br /> r t <br /> Sipnature ol Au�t <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> ; . . . 1- . . � . � K17� IN��' . -� �C1� . `..��(' ��C_r Vv� �.� S�- �� . . G�.�,�G'(P•� .. � <br /> � � <br /> I . . , I , ; , � <br /> : i � � ., / // <br /> � . : L'24.S.�Ivi Gu.�nrc-��c.� .-�?� �J SnPw(:,/ /✓1. �1u1/-�t-�i��.v+� <br /> l . _.�_�__.�.�--. . . � r I . <br /> , . . .� � . 1 . � ct�IPv) iNl�1S {-� � r CcilJA['..Q prC c� ✓� c1� c� I��.' Ccv�N����f-l�n <br /> I 1 1 <br /> .. ! �-T-' . , 4'VlG�il l'. -.{�'� . C� . ii. � . .� �[.4�.'� Irl L�GtJ� -VVPT �.. .��/ H � <br /> : . . � . . '�ve'. � .- <br /> ; ; � . � . � . � �, s �dr ��F � kl <br /> '. : .._..--- —i-- . . . �I.,�va.� �,c.� . .`x o ,C� . :70 �� . . . . � - . . . . � F_ <br /> ; : : : : � ' . f : : . ; � �. <br /> : . : . ._...__�--:-� : :-: ; : : : : : � � <br /> , _ �r�� � � The undersigned owner herehy ag�ees �o holtl and save harmless � = <br /> � � Ihe Ciry ol Everelt vom any ano ail cialms lor damapas, coets. F <br /> erpenses.or causes o�action thal may xrise becau6e of Inetallation ~ �� <br /> . . . . . . . . . �7 L <br /> , _ , , , . . . . . � � � - - and meinlenanco ol the improvemont or other righUol•wey uee �2 <br /> . , . � hereto applied lor and further agrees ro remove same upon nolice Q �� <br /> . � Irom e City end to mD�ace public o�opehY demapad thereby. � C� <br /> r-_l//�—.�'/!�i ". j'-.��'0� � � c, <br /> �A PROVED FOR CONSTRUCT N � OATE AC OWLE EMENT OF CONDITIONS QQQ <br /> � � t' <br /> `���/�����i—�i—�� � Gt�' �. C c�.i ��/y9i2 SZ ; <br /> � <br /> /AP ROVED AS CONS RUCTED DATE SI NATURE OF APPLICANT DATE f� <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION � ` <br /> POST ON 25g-gg11 � <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION ; <br />