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, <br /> ---��.- <br /> r� .- <br />� 'l <br /> il <br />� r <br /> -� <br /> I <br /> I <br /> I -� <br />, � <br /> i <br /> everen APPLICATION FOR PUBLIC W�RKS PERMIT <br /> � TYPe or prinl'IeerlY wlth Ink <br /> PRESS HARD•YOU ARE MAKING COPIES pERM1T NO. _��- <br /> t,, PUHUC WORKS � <br /> t��fTT,WASHINGTON Z BLDG. DEPT. NO. ��' /��IO T' <br /> �'OVJNER C7 AGENT DATE L��l � �,3 <br /> APPLICANT/FIffM REPRESENTED •�F/�/��5 "" �` <br /> /G I J- L 1- ��/ �+-1 CITY �v��r �— TELEPHONE 7��3-��S � <br /> ADDRESS .�L' - <br /> HEREBY APPLIES FOR PERMISSION TO r��J f W � <br /> ATTHE FOLIOWING LOCATION � ot o2- ' �R-a �-,�1 -"��—�'-��- L°�—^Q �-'a�^ �"^ <br /> Attach five(5)copies of preliminary plan or propose�wdrK DraW to scale and show the following as applicable: _ <br /> • Property lines and street identity. 'Topographic changes requiring cuts and tills <br /> ' Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. ' On-site dr ' a�e systems when required. <br /> • Existing and proposed utilities. ' Erosion,�c ntrol methOds when required. <br /> ' Centerline of abutting right of way. ' North w <br /> c7 /�L <br /> Signeture ol p�' anl <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS; <br /> , /--��' .� �ortvr'� �i�S : : , <br /> . . . . � � . : --: ; <br /> C � : ; : : � <br /> � : _ : � _�. f --1 : . . : : . � ' , _ : , -t : , � . . <br /> � ; . , . . : : , : . . . . . . . . : . : . . ; , . <br /> ; _�_____4 _. i _ t . __� _: _ _ ? . :i . " , ; _ ' I , <br /> 1 � ; : . . I . . ' : ; � : : ' 1 � <br /> ^�^ i . , ' + <br /> .__1 '� _:_._.� _ __ _ .--�--____ , --s- ---}-- - . . <br /> , . : ' � : ' t • i : . . . . , : ' : : <br /> : .-_ �. : _± ; � ; , . :� � . --- - <br /> � � � . � � . 1 . <br /> ; . . . . . . .�, . . , . ; <br /> ! "-'�r'�� �� ' � *� The untlersigned owner hereby agrees to holtl entl save harmless <br /> ' ' ' ? ' �+~ � � !� � � � Ihe Clty ol Everell Irom any ena oll clalms �or demepee, coets, <br /> . . . . . . . . � . . . . . . � . . . . . . . . . <br /> . , r.pen9e9,or C:uses ol nttlon I�et mey Brise betauea Of InelBlleliDn <br /> � . . . . . . . . . . . . . . . ond mainlonancn of I�e improvemenl or ot�er riQh4n4w�y uie <br /> . . , , . . . . . . . . . . . � hereto npPlled lof and lutlhef a�raes�o romove 9eme upOn no�lce <br /> . - � � � � � � �rOm �hB Ciiy antl b rPplete publlt pmperty dHmeqed I1lelaby. <br /> L � p� CO T .UCTION T AC/I� LEDGEME F CONDITIONS � <br /> � �Z�� /�/L�A/� � '� � <br /> qp O TRUC ED DAT[ SIGNA U� APPLICA AT <br /> PERMIT IS VALt FOR � AR pOST ON CALL F��R INSPEC ION <br /> ,iOBSITE 259•88i t <br /> EXPIRATION 24HRS.BEFORC�ONSTRUCFION �1 j <br /> �I <br /> 1 <br /> L � <br /> .J <br />