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r -� <br /> -. <br /> r <br /> . everett APPLICATI�N FOR PUBLIC WORKS PERMIT — <br /> � TYGe or PriM Unvrly wit�Ink f( <br /> PRESS HARD•YOU AfiE MAKING COPIES pEHMIT NO. �'��—� " Z <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON p BLDG. DEPT. NO..��_�/�a w� <br /> r � OWNER ❑ AGENT DATE .f:. � .-. g�Z-_�. �- { <br /> APPLICANT/FIRMREPRESENTED .�ARlQ ,L--_Be���el_. _ _ _. .._ __ . _. _.___.___ <br /> ADDRESSo�I_�I7aDhI�cE:�'�- --CITY �'��7_�—TELEPHONE �55" y487 <br /> FIEREBY APPLIES FOR FERMISSION TO CQ/1S-�J11(_L!_—���X a y—G��PJ�-G-e.— �N <br /> �eAtZ—.af�Rep_e�2ty---- -- <br /> AT THE FOLLOWING LOCATION _.�IL�mUl1_1QQ-�—S�—�C!Q�e:/_C�—LL.�A��� <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and 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 th2n normal foundation. <br /> proposed structures. ' On•site drainage systems when required. <br /> • Existing and proposed utilities. • Erosion control methods when required. <br />'I • Centerline of abutting rigM of way. ' North arrow <br /> i / <br /> --—�c_-�,u� -t,Z/�.c— — <br /> � Signelure ol ADPl�canl � <br /> coN�inoNs: PUBLIC WORKS PERMIT <br /> 9�L�/�Z �)v i�rrRc7— a,v �e/c� <br /> �_1 <br /> ?-r ' t '; T-i_'T�' - ' .. _ i ; � _ � r � ,_ _ �`,_ <br /> L � 1 � 4- <br /> � • { ' . - - � I '. � � ( ' ` . <br /> � � I ' .� } � _�. : f ��� � ; , , , , � - i <br /> , , � <br /> .._l � � � � i i � � I �.. �'� � ' � ' �._ ' �� ��._�_ 4 . _ . <br /> ._ _{.. r <br /> _ 1 �.�� + �-�_ ._. �- �� �. ._ I I..� I_ ..— . � ... . � i .._�. i I Z. �. <br /> 1 - ` � ___• `' 1 . <br /> �-���I �_. . i , � � i .t.�.L . . ._. �i .�..: : i � .. I 1 ... ( `��_� '_.... �.. <br /> ' i . . . . . '_. � ., i <br /> _. i , 1 � i <br /> r i... <br /> �� , , !. : . '.. �. .. , :.. <br /> �� , ;_ } . - , ; Y � 4 <br /> � : � �, � r� � 1 �_� � i ,_�. <br /> ,.� ' _ , , t ' 1 i <br /> � . <br /> i � . _ . _ ; <br /> � .., . <br /> .� , i I � i� <br /> �j � : � <br /> _�_,_ <br /> "'���" � �� ��. T�e untlersigned owna�ereby aprees lo hoiA an0 asve�armleu <br /> � � � � �� Ue Ciry ol Everetl trom any ana au ciaimn lor tlam�qet, cott�. <br /> ezpenses,or cxuses ol action I�el mey arins beuuee ol ineldl�tion <br /> and maintanance ol t�e ImDrovemenl or other Hq�tcl-w�y uas <br /> herelo applied lar antl lurt�er egreea to remova eeme upon notice <br /> � � Irom Ihe City and to ruC�ece pu0lic property tlem�psd I�eroby. <br /> �i� ��----i 9-�L <br /> OVEDFO � ONSTRUCTION D TE KNOWLEDGEMENTOFCONDITIONS �p�=����y� � <br /> {�. � ' � Il Z ,� �-/6—F2 <br /> AP ASCONSTR CTED DATE IGNATUREOFAPPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTION <br /> 259•8811 <br /> EXPIRATION JOBSITE 24HRS.BEFORECONSTRUCTION <br /> J <br /> L <br /> L J <br />