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r` <br />� <br />r--- --- --- ---------------- -- -------- <br />! "'"e" APPLICATION FOR PUBLIC WORKS PERMIT <br />� <br />i <br />------� <br />e c�`� <br />TYDB or print clearly with ink I <br />PRESS HARD • YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. a � _ <br />EVERETf, WASHINGTON d Q^ <br />�OWNER ❑ AGENT DATE ,� —%O — C/o"" BLDG. DEPT. NO. <br />APPLICANT/FIRM REPRESENTED �fiLi_G_L��L+I_GG�'_/")-- _ <br />ADDRESS ��%�� �� fri t��CIN f���TELEPHONE ' a/ <br />HEREBY APPUES FOR PEFlI�IISSION TO <br />1 �9 <br />� /,u��af' �"•-r� o r�_�y-� <br />ATTHE FOLLOWING LOCATION <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale anb 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. * No h arrnw <br />Signature ol Ap�. <br />PUBLIC WORKS PERMIT <br />� -- <br />� CONDI,TIONS: <br />� � � � .: : : . : . � '�'`''l.�N^"'F' � CJ e a..� �•v� `` .I -C�Kc_� •� � I a...c�/scc� � v� <br />� . ; . . ! . . . . 1 ( (��Gt h a' � O ro�� r � � -2 - 8 2r- � <br />..:,.. ;. Q` y �Qi <br />--: ��� : : : : : : : : : : . : : . <br />��.. ..... <br />;:�',:::�:::. f: : : <br />:..`:. ..;�._� .:l '_.. <br />. : .: ; �:-- .— , r -- -{- -; i -- : � . . <br />� <br />- - . . . � .+_:._---- - . � �--'�:-- <br />f:::.._� ;-..��:: <br />I <br />.__ .. . . - . . / . . . . . . . . . <br />. . _ . . . . . / / �% � i <br />G---"`�3 -�'O Z_. <br />:TION � � Q �� <br />L,�� c :. u <br />�-- - ----- �-- -------�1 <br />PERMIT IS VALID FOR 1 YI <br />EXPIRATION <br />� ' DATE <br />AC <br />The unAersigned owncr hereby egrees lo holtl end sece harmiess <br />the Clty ol Everett irom any antl au cl9lms lor demepee, coet0. <br />EMpB115E5, M f011325 O� 0Cfl011 �h2� rtlBy.ltl6B bBGUBB O� IIIS�p110N0l1 <br />antl meinlenanca ot Ihe improvamant or other riqht•ol-wey uee <br />herel0 applied lor entl lurther agrcea to remove bame upon n0tic8 <br />Irom Ihe City end to replece public property OemapeE ihereby. <br />OF CONDITIONS <br />I POST (1N I CALL FOR INSPECTION <br />259-8811 <br />JOBSII'E 24HRS.BEFORECONSTRUCTION <br />, <br />