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e"°re" APPLICATION FOR PUB�IC WORKS PERMIT <br />� �- Typa or prinl cleerly wl�h Ink <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. h�2 ? F. � <br />PUBLIC WORKS <br />EVERETf, WASHINGTON BLDG. DEPT. NO. <br />[�OWNER ❑ AGENT DATE S- J 4_�_� <br />APPLlCANT/FIRM REPRESENTED = r•� i �� T �� � • �� �—��� <br />ADDRESS ���f .��' Ll' � i �-' 1 i i�: l� i� CITY LU� i�`-r TELEFHONE +�� �-7S �' f <br />HEREBYAPPLIESFORPERMISSIONTO �'''�ti'rr'�ot' Sia��l•� •how��f.�� r•:s �r+n��'� <br />ATTHE FOLLOWING LOCATION ` ���' � ���/FSS.tt,,' <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. <br />• Outline and dimensions of existing and <br />proposed structures. <br />' Existing and proposed utilities. <br />" Centerline of abutting right of way. <br />LI <br />' Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On-site drainage systems when required. <br />* Erosion control methods when required. <br />• Nprth arrow � <br />C.O.NDI.TIONS: . _ _ . . . . - _ . . <br />i......... <br />:........�.�00�, �!`niviS..H^u.S _ .J� ,�"�ShTl�n�c>C �tn.:Z.�. ... . . <br />! ::: : s:��ie sew�� <br />�.:":.::::.. .::..::. .._._.__. _._ <br />__: .:. a. �7� S e c' xl s i- i h c c��� u� wa� c� .. � .: <br />� . . , . . '�( . � .�� / �iiL.� f f.��'� i19R/r.'% id/H�"��� . . . <br />. . . . . . ..J.. .�i2....`>iC�.+ .�Gn YG � .. <br />_�:_ : : : : : . a/��'�l� � /:��-:lt_ . : //��„��.- f��.: 1/ ,�., ��,� ,��N <br />' . . . �1 � . . . . /c? T J / l.� . Gc:.., l�s:) i.•� � �O y� ['.�( %/cL/ ��T: �'IP/•ri S <br />. .-. . . . .} : . . . ��z? . �ir f�r'�- t i�� 5 <,nl�� �-c�, <br />............. . <br />,....i. . <br />. ._ �1 �_._;_._----, _ �-_ • ._ _ . _ . . _ . <br />. , _ , � , , , , , , , , , , , , , , , , The undeisigned owner hereby agroes to hold and save �ermless <br />, , � , , _ � . , . . . . . � . . Ihe City ol Everelt tmm any ena eu claims lor Eemepes, costs, <br />. . . . . . - . , � . � - . . . . . . ezpenses. or causas ol actlon Ihat may erise because ol installatlon <br />. . . . . . . . . . . . . . . . . . . . . . . anC maintenance ol ihe Improvem�nt or other tlphFol-way use <br />�.� �� � � � - hereto applied for antl b� .her agrees b remove same u0on aotice <br />�- ��� � � Irom thn Cily and �o iaplece public Nwpetly dama9ed t�ereby. <br />��� �� . .%'�—f��� <br />OVEDFOFCONSTR 10 DATE ACK �LE F.�NTOF N ITIONS <br />' � ' ' - -�%�.,�� � %'4 .'� Z <br />APPROVED AS CONSTRUCTED DATE S NATURE AP LICANT DATE <br />PERI111T IS VALID FOR 1 YEAR <br />EXPIRATION <br />POST ON � �ALL FOR INSPECTION <br />259-8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />L � <br />