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— -__. _ �� <br />""'"` APPLICATION FOR PUBLIC WORKS PERMIT <br />� , , TYGe or Vrint clearlY wit� Ink <br />PRESS HARD • YOU ARE MAKING COPIES pERM1T NO. �� 3 � <br />PUBLIC WORKS . �� 0 <br />EVERETT, WASFNNGTON ,�/ '�i� BLDG. DEPT. NO. <br />❑ OWNER �I AGENT DATE ,I�Ly- o�— <br />APPLICANT.'FIRM REPRESENTED � �' � n nr � ���i cu�s <br />ADDRESS —_�� �'� �� - � � �>'"--�t�C CITY ` !""�r� TELEPHONE �% � �`' f� � <br />{ <br />HEREBY APPLIES FOR PERMISSION TO ' � ~ � � � � � J ��� � '� � <br />— — I � t, <br />AT THE FOLLOWING LOCATION ��� �—' -��� � � �^l�t <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br />• Property Iines and street identity. <br />'� Outline and dimensions of existing and <br />proposed structures. <br />' Existing and proposed utilities. <br />• Centerline of abultfng right of way. <br />' Topographic changes requiring cuts and fills <br />other than normal foundation. <br />� On-site dreinage systems when required. <br />• Erosio� control methods when required. <br />' North arrow <br />��:.. � � � - ii /� - <br />. Sipnature ol Applicent <br />'-- PUBLIC WORKS PERMIT <br />CONDITIONS: <br />� ,......-• ; <br />. �_ � _.� � : � _. .�- t - -- . . . '� .. . . . ._ _ _ . _ . ; _, � �_�_ <br />'..:;.����. ... � .... . ..... : ... �-. :.. I..,; <br />�;�-�;:�� :. t�_:,::.:: :.:;..::::.: ::; <br />� � s � �+��_�; � : <br />�.__.�_�_� � . i . . , : : . <br />: : : ; .� �-: ; � . 4--. . --- : <br />! ::: � ; i::.; .... <br />_._, _:.._:_i . _. . . . . . <br />_ ` ;+.-�---- ;---- . i . . � <br />, . . . . . I . . . I . . , . <br />. . . : 1 , . . � . . . � . . � � . . � f <br />. . . . ! . . . . . . . . . . . . . <br />, . . : . . . . . ' C , . , . . <br />�. ,/ <br />'" ; f <— .,�i`--. ; , .^----'—'��� �v "�/ <br />' PROV- FOR CONSTRUCTION DATE <br />n n`��.�� �I �sl�z <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />The undersigned owner hereby aBrees to Oold end nave hermleaa <br />thn Cily ol Everetl trom eny ana au cielme lor dame0e0. conte, <br />erDe�ses. or cauaes ol ection t�at mey enae bacaune oi Inet�llellon <br />and maintenence o� lhe improvemen� or olher ripht�ol�way use <br />herero av0�led br enA lunher eBreee to mmove eame upon notice <br />from Ihe City an0 to replece Du�lic prope�Y dameped thereby. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />XSIGNATUREOFAPPLICANT DATE <br />POST ON <br />JOBSI7E <br />CALL FOR IN5PEGI Ivlv <br />259-8811 <br />24 HRS. BEFORECONSTRUCTION <br />