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<br />"'""` APPLICATION FOR PUBLIC WORKS PERMIT
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<br />r pUBLIC WORKS
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<br />Type or pdnl cle�rly wit� �nk
<br />PRESS HARD • YOU ARE MANING COPIES pERM1T NO. �'� r s I
<br />DG DEPT NO �� d �6 �'"�
<br />EVERETT, WASHINGTON , � .�• � BL . . .
<br />q OWNER ❑ AGENT DATE : _�
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<br />A.PI'UCANT/FIRM REPRESENTED _a, � ���� I �-_— 1 � � � - � — —
<br />ADDRESS '� �! � i j�') i �' d lI� ��� � I CITY �� ��l � l�I TELEPHONE ����� � I ��
<br />. ,� 1 � / �-'
<br />HEREBY APPLIES FOR PERMISSION TO �' � / �� ��� � � � `� � � 1 + � / r"� �'[' �:�,)� l'f 1 '�
<br />AT THE FOLLOWINd LOCATION �� � ��� � � �V � . . � � 1 �f�,, � � �"�
<br />Attach five (5) copies of preliminary plans (or proposed work Draw to scale and show the following as applfcable:
<br />• Property lines and street identity.
<br />' Outline and dimensions of existing and
<br />proposed structures.
<br />• Exfstfng and proposed utilities.
<br />• Centerline ot abutting right of way.
<br />• Topographic changes requiring cuts and fills
<br />other than normal foundatfon.
<br />• Un-site drainage systems when required.
<br />` Erosion control methods when repuired.
<br />�• North arro� � .� � �, , �
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<br />CONDITIONS:
<br />� 1."�l,e: loc`n-r'�o., �{ -Fl,e :s,.�t s,�,,,,�i •s�-�•.b -�o. �o�# �
<br />I . . .... YN�4�i.. �b.�' .VC'fi�lY�l�. 1 I.o i:�' .. w,i-1.�,.:. .t'nSc-�.�.�.P.tJ�..
<br />�' , . . . ' cZrP« '�i-c�. 'ii^c. '�ct-1/�Gr�rc.� c7- �H�. �. LV. J-nd/J.
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<br />...� �1- . ieln r�c:_.. . o-Y. s.�c��'. .:�c'y•C�. �15. . f2c}�t���Pc� .
<br />j �. .. . i-�. 1+1o1s -�- 10�. �e�On c, bi ic�r'� S.N�'; �c�.ic' �OP�r '�T �/
<br />l . . . . GI.i-� :�i- . Cn.�d. �: � e.,�r «�{zl� 5 i3.�' 1. .7�
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<br />_ . . . . . RPn,�� �� 6 Jk.� �H1,�dF� /'] /
<br />4 � . . . �� .�Oo� �7C�r,.?�: . /hrr�f . b,�. --�i��,�l-��„r.f//nJc 5����E'_ �P�.,e/
<br />�-- ''''' ' T�e untlarsigned owner �ereby eqreea to hold anA save �ermleas
<br />' � � � � Iha City ol Everetl trom any eno �n cleims lor d�mepe0. costs,
<br />;���. � 50A Or CBUSeD Of et�lon ��81 m!y eflse bBCBu!! of Inat�ll��iOn
<br />/ and maintenence ol t�a Improvemanl or other rip�l-of�w�y uae
<br />., 0�!C Jf w. . /{✓� �C - k�� . hereto ep011ed lor end luhhar aprees �o remOve Nme upon nolits
<br />�, , �.� ��J /� � irOm lhe Giry anE to rapleta publlc property demeped I�BroCy.
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<br />s-� -��
<br />DIjTE
<br />�y�3
<br />DATE
<br />PERMIT IS VALID FOR 1 YEAR
<br />EXPIRATION
<br />�� ACKNOW�EDGEMEN�CONI
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<br />� �;''i„�-l. ( .;y�� �.
<br />POST ON
<br />JOBSITE
<br />S-z�- B z
<br />CALL FOR INSPECTION
<br />259-8811
<br />24 HRS. BEFORECONSTRUCTION
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