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everett pppLICATION FOR PUBLIC W'ORKS PERMIT <br />� TYPo or Ptlnt cleadY wilh Ink <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. �'�� 3 S <br />PUBLIC WORKS <br />EVERETT, WASHINGTON �?'(y` B L D G. D E P T. N O.__ <br />if-J OWNER ❑ AGENT DATE f S-�, D <br />APPLICANT/FIRMREPRESENTEO'�__ ,L����-C1vJJD�r - _ -- _,--- <br />ADDRES . ��Q �' �" N �nci-[J �.,(�� �rJ_3 _CITY i�L`K1<<� ����� TELEPHONE � �- (%� <br />HEREBY APPLIES FOR PERMISSION TO I�� �-LZ�—�X � 5"� � uL�G.�� _ <br />� <br />ATTHE FOLLOWING LOCATION J �O cY I+IQSSuu S't', ___ <br />Attach five (5) copies of preliminary plans tor proposed work. Draw to scale and show the following as applicable• <br />• Property lines and street identity. <br />• Outline and dimensions of existing and <br />proposed structures. <br />* Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />CONDITIONS: <br />a�. <br />�� <br />BLI <br />` Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On•site� rai age systems wh required. <br />• ErosiqRco�rol methods wh�required. <br />, �i...�rl�rrnf� ii �� <br />IT <br />i�' 06� c�ra,�s ,�,ts-� b� -,��l��l�nrp i�-1� 5',�le 5�..��•�. <br />�1f��j `YCcIM[f,2 G� AC1r��st,< -,i� ,.��J�•t f�.U.�J. 1NH'a�' �vC �i�[fJ�.1' <br />��� b,:,.l .� c.- � y.G-t s R-1-� ��(t�i- � o.. o�(- J-�._ %�� t,l,�c. w�,. l s <br />�. ..•, �, c �i.-� <br />�P_br.•. �Mn�.��..� ��..�� �}�a-t �»bl,� �U.w, s/�n�/ br c/r'cl.n i..� u� <br />AGI�I� Af ct) tPCN�l�.J bl �N.•� �:6/ic �(-'r.-�'f 1.v}p1c.Q�/. <br />1 Y <br />��!����--�- 5�8z <br />, ROVED FOR CON U � N DATE <br />' �j� �� <br />� AP OVED AS CON TR CTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />L <br />'r- ' , �—f-;__._._ .-�,,..:.. .. .. . , . ... . . ; . . <br />�—.-- � T' I , . . ' ... ... <br />The undnrsigned owner hereby agreos to holtl antl save hermless <br />t�e Ciry ol Everolt irom any ana au claims br damapes, coets, <br />exPa�sos. or causes ol action Ihel may arise because of Installalion <br />and mainlenance ol Ihe improvement or other rip�Pof-wey uae <br />herelo applied lor and lurlher egre?s to remove seme upon notite <br />Irom t�e City and lo replece public property demeBed Ihareby. <br />�� <br />� . � CALL FOR INSPECTION <br />POST ON 259•8811 <br />JOBSITE 24 HRS. BEFORECONSTRUCTION <br />1 <br />J <br />� ;_:� <br />n <br />