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0 <br />everett APPLICATI��N �OR PUBLIC WORKS PERMIT <br />� - TYPe or Vrint clearfy with ink � <br />7��� PRESS HAFD - YOU ARE MAKING COPIES pERMIT NO.c�� �� � �� <br />PUBLIC WORKS ��2/ '�`�%y�L' �f�U� <br />EVERETf, WASHINGTON /_ BLDG. DEPT. NO. <br />�OWNER ❑ AGFNT DATE �2�'�� xZ <br />Y` <br />� y <br />APPLICANT/FIRMREPRESENT[D Lvere��'r',rk�_L�FC[e�lip�__Dyei�__—_-_._— <br />30f�� 4Jei'r,�,;,-� �iYC CITY - f; c.' TELEPHONE 75 ' 0 3/ <br />ADDRESS — y I \ <br />���_.���1��--�- �-�'- , � � <br />HEREBY APPLIES FOR PERMISSION TO E••�"' �rf�! cu� crL Iace�rc,� ,i -3 c!�a �� ? <br />�� <br />y c�r r c� n.,...,« <br />;� � C <br />i� `•. <br />AT THE FOLLOWING LOCATION � 4'�� �� "K w' �^�n �`"w-"-u-`-"""""' '—'-�— <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following c.s apP�icable: <br />• Property lines and street identity. <br />' Outline and dimensions of existing and <br />proposed structures. <br />� Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />CONDITIONS: <br />�r <br />cZ. <br />� ,� <br />APPROVED AS <br />�� <br />' Topographic changes requiring cuts and filis <br />other than normal foundation. <br />' On-site drainage systems when required. <br />' Erosion control methods when required. <br />� North arrow <br />7�ae/�P� �v EJe .�'.�ri�����'/ !-TY�QcArc( C��'4���/ 3�nr/�r�r�. <br />� v <br />C��n4�c.J/OwS o r �H^.�.� 7 �'►t%r-� J`�cfP. �ja�" [>� i7SI�Pr/.'S. <br />� 6�. «<�/,��r�r-' -�4: . <br />PERMIT IS VE►L!D FOR 1 YEAR <br />EXPIHATION <br />--a�� f Z-- <br />Z <br />The unAersi9ned nwner ha�eby agr�es to hold and save haimless <br />Ihe Gily ol Eve.reu trom eny antl au claims lor AamaOes, costs, <br />ezPenses, or causes ol acUon Ihat may atlse because of installalion <br />and mainlenence oi Ihe improvement or other riphl�ol�way usa <br />hereto applietl lor and lurther oqrees lo rem�ve seme upon nolice <br />Irom If�e Ciry antl to replace public pmPerlY damay..:i thereby. <br />ACKNOWLEOGEMENT OF CONDITIONS <br />SIGNATUREOFAPPLiCANT DATE <br />� CALL FUH INyreV i �vre <br />POST QM 259•8811 <br />. OBSITE 24. K1�S, BEFORE GONSTRUCTION <br />