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everett pppLICATION FOR PUBLIC WORKS PERMIT <br />e <br />BLIC WORKS <br />Type or Print clearlY wAl+ mk ��. ���� <br />PREFiS HARD - YOU ARE MAKING COPIES pERM1T NO. — � � <br />PU <br />EVERETT, WASHINGTON �� <br />O OWNER p� AGENT DATE ��-��--� <br />�� r . ��t- � — <br />APPLICANT/FIRM REPRESENTED �-- - --- /� <br />�,'-Jy�if IJ<'I��cr,� P�,.�G�.�`�C� KJ �ITV <br />ADDRESS - � - <br />��/, J.� �, �/,- ; <br />HEREBY APPLIES FOR PERMISSIOiJ TO <br />AT THE FOLIO�VI^!G ! OCATION _� <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show Ihe following as app�icable: <br />� <br />BLDG. DEPT. <br />i��'- "%��S �'� <br />�r�� e TELEPHONE '" <br />• Property lines and street identity. <br />' Oulline and dimensions of existing and <br />proposed �:ructures. <br />� Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />CONDITIONS: <br />� �� - <br />• Topographic changes requinng culs and i s <br />other than �ormal four�dation. <br />� On-site drainage systems when required. <br />• Erosion controi methods whEn required. <br />� North arrow � �, j <br />��, i��,�� � � - <br />,�( �r ([ — <br />—% / i9ralu� ol APPlicenl <br />RKS PER <br />��// - /� l <br />IJC-� srlX w�u< <br />jS�n�1-� c,J C � �j <br />i � v� u'!�� � <br />E -Z c�R� PQc-sc-+�r <br />c ve a �7� � <br />� G�(J <br />S/.t1,U GU'1� <br />Iv� W./ IJ S%1� LL <br />SC t'R�. A- I F <br />� <br />�- � "' �t-�e�, <br />C�l G�r'T��. <br />��. <br />� �,, DR� �e v-� ��� <br />�z„_ <br />/�` � <br />d <br />7t/�d vG i� s�r� � <br />�,x �/�r D�) �/ 7� � <br />wER TM 11 S VALM FOR <br />YEAR <br />�XPIRATION v/�y/�� - <br />M!p�JA�. �LUS <br />�_ , <br />� �� v �- C vl� <br />� �J �ru1 �L_ <br />� � S�- Tr� (.vC- si <br />TFe untlersigned uwner hereby agrees to hMd and nave harmlas6 <br />Ihe City of Everelt Irom any ana au ciaims lor demeges, conle, <br />e�pe�sxs, or cuuses oi aclion Ihat may arise Doce�ee ol Inftelletlo� <br />and mainlenance o� Ihe imDmvemenl or other ri0h4o4way une <br />herelo apO��eC br and lurthe� egre^s to remove same upon �a�«e <br />liom the C��Y and to �e0lace public Property damape0 thareby. <br />ACKNOW! EUGEMENT Of COND�TIONS <br />SIGNATUREOFAPF'LICANT DAYE <br />CALL FOR INS►'C�. � ��n <br />P�DST OPi 259•8811 <br />JOBSITE 24HRS.BEFORE�ONSTRUCTI7N <br />