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� <br />°"�'�" pppLICATION FOR PUBLIC WORKS PERMIT <br />� TYPe or print c�early with ink <br />PRESS HARD • VOU ARE MAKING COPIES pERM1T NO. �� �� <br />PUBLIC WORKS BLDG. DEPT. NO.�Lp��3 <br />EVERETf, WASHINGTON /� O � p �� <br />❑ OWNER ❑ AGENT DATE _1tK�--}- � - � <br />APPLICANT/FIRM REPRESENTED _—I�-� �-` � �--''� --------- -- <br />ADDRESS _23+� l F����f� �� CITY �r�^'^ TELEPHONE ` <br />HERESY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION � <br />Attach five (5) copies of preliminery plans for proposed work. Draw to scale and �how the following as applicabie: <br />" Property lines and street identity. ' Topographic changes requiring cuts and fills <br />• Outline and dimensions of existing and other than normal foundat:on. <br />proposed structures. * On-site drainage systems when required. <br />• Existing and proposed utilities. • Erosion control mathods when required. <br />" Centerline of abutting right of way. ' North arrow� �/ � <br />CONDITIONS: <br />LI <br />, <br />' �1 -I a ,. L '_ ,.._ i E � -�— ' � � � —t <br />��:. �� f� ��_�j � i l i� <br />_ ' ' -4_� i I � � � L l T ' . j_ , � . <br />- 1� _ <br />�_r, i s�. -- ;_� ; � , { � _�-1-�' ; ; {�� ` � �_ `-�-'_ ,-_ �_ i �'` `, :-f ' � '� r � '.�+. <br />, i i ` ` � � ` ; <br />1 � Z -�-^ <br />r-'-�-? �-;--, � � ,T 1` � , I ! , � _� , , � ' �� i � j ' ' i '{ � � � <br />� t_��i;Lj..�,�ttt � j1.� l;f��l� l�t;ii ��_? II 1'lli i <br />- ' � � � i i � � I � { ' � �-+ i <br />� <br />. �r .... i I I 4 Y ; _ r� 1-� .t { �.-- � �.-+ _' � � .� �-. i �--� 4 ---" <br />j Tj � <br />��i,�� � ri,1 i 4 I I.;.. � t 1 ��- 1+� � �._'� 1 .I.�� �� �.. i �� �.1-!_ <br />I ' lJ.. � T�---{ , ���`( � 1 T;. �. �� l.. �..r `. t_ ( � � <br />� � �:- J- 1 I �.-..- a--. r--�— . <br />�' �_ � � '� { � 1�1 1 '_;. <br />' :. <br />' _ ...� .�_' '.. <br />�- ; . 1—j <br />_•._�__L�� :_...� : <br />oocn� <br />PERMIT IS VALID <br />EXPIRATION <br />'; <br />� F Ll � . _ � �... {--� � � . 1 i � ; . -. _� ,... � ,_ � � . <br />� � <br />� , f '— i <br />�,,��_t '- fi,, --, ���_ �,_�I �_� , i�_,�t ! i <br />� �� <br />, � <br />. � j ,. . <br />� -- �, �t—' � • �—` �� L' ' �'— � i._ii_ . .. <br />i �-� � _ i.:.y..-! 1_I r t�-t � 1' i� ' � . _I . . � <br />L__ 1 1 t_ i � ; I �, � <br />1 , i. _, _ t _ ' <br />:� '„ �_._ `' _ <br />;_ � , , � , -, <br />, } i f 1... +1-- � <br />� � ���� ^� The undersignetl owner �ereby agrees to holE entl save �armleaa <br />��' i ' the Cily oi Eve�elt trom any ana an cieima lor dem�qe4 coets, <br />� � ��. ezpenses, or causes of ection thet may eriae beuune of inetdlatlon <br />end mainlenance ol Ihe ImOrovamenl or olher Nqhl�al•w�Y u�e <br />� hereto applied lor end luriher agreea to ramove aama upon notke <br />�.% � � / <br />trom Ihe City and to replece public property Oamaqed ihereby. <br />�� <br />�l; <br />OF CONDITIONS <br />� <br />�, DAT C/ SIGNATURE OF APPLICANT DATE <br />1 EAR CALL FOR INSPECTION <br />OST ON 259-8811 <br />JOBSITE 24 HRS. BEFOR� CONSTRUCTION J <br />� <br />� <br />