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everctt qppLICATION FOR PUBLIC WORKS PERMIT <br />� TYPe or Prinl cle9dY with ink o� � <br />PRESS HARD • YOU ARE MAKING COPIES pERM1T NO. �� <br />PUBLIC WORKS � / BLDG. DE?T. NO. <br />EVERETT, WASHINGTON <br />❑ OWNER ❑ AGENT DATE � <br />APPLICANT/FIRM REPRESENTED � <br />A�DRESS ���� �� ` `'T� <br />HEREBY AP�LIES FOR PERMISSION TC <br />. c r I� -�\w !' � <br />I b 8�2 <br />:�5 c' <br />J <br />1 <br />�/ � •— <br />- C�Ty �� TELEPHONE�`�'�`��� <br />irLi[1P c�� �o� I iVivPS��<<C.'�-\o�-. <br />T - <br />) r�, ��. ....�a 1 i P S � a Y, <br />_ � � %� __-� <br />� M � �f d�ld�� <br />�� . � � <br />AT THE FOLIOWING LOCATION � � � <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 fflls <br />' Outline and dimensions of existing and ,,` <br />other than normal foundation. <br />proposed structures. ' On•sitey� ,ama e systems when �equired. <br />� Eristing and proposed utilities. ' Erosio �'on I methods whek� uired. <br />• Centerline ot abutting right of way. ' No arrq � „ <br />/ ' <br />. .��F- 'Z � �C� L -/ <br />CONDITIONS: <br />� /1%� <br />;_ . a S� <br />;i; �� <br />� ; <br />r t . r , -'i .. , i <br />MI <br />� G'l� �l v� (�� CON i i-ru c l- lc� .-� C'� u��.+�N��¢-- <br />Cr // c) c ti P �/ U,-,/ :�-� -e i'� o �-V-h S l. u✓I l C( P r-- <br />��e /z�a �l. I ; <br />� 4J - � �� i :. <br />!'-�- �--+-' ti-r � i � � '" 1 : <br />,- j � , i�� i -, <br />; i ,-i �� � ii?I �j �ifi �i <br />�-i1�t �_i ,�- +� -�j.��,��- , { : � : <br />� _; ,._ _ ��.� � —4 -1- -' —�- T_ � � ,_ � �! � ' -; , _, � : <br />� rf �a� <br />� �,,-t� ;i_ � ��, � � ' , <br />{ _I;� �;},� .r., � }- ' , r�t�,-� ��!:. i; <br />� �: � _ , <br />� . ,�_� .� ,i , �__`�; <br />�. � <br />r- r 1 � 7'- i � I L: ._ 1. _ � _.._ .-` -- i '"� `t �?- -i I <br />?.+--�- } i '—�- 4 -t ".l i .........! . , _.; .. . � <br />.+_, � � 4-rt + � � -t-� � ! , . . <br />� _�. � j.. _ �.._� <br />. _`. . } ..'_�-�-�-� } j'^- <br />PERMIT IS �ALI <br />EXPIRATION <br />�� �•�"" _ <br />!l��2. — <br />' ' 7he undersigned owner hereby agrees lo �old and seve harmlees <br />�� �^�-� the Cily ol Everett �mm eny ena au cie�ms ior uama0ea ws10. <br />�._� (� . expenses, or causes ol aclion Ihet may eriae beceusa of inetdletlon <br />� entl meintenance a� �he improvemenl or ot�er riqM-ol�wey use <br />horeto epPliad�or end luh�er aB�eea to remwe same upon �otice <br />Irom Ihe G� antl)o replace public prbpBrty deme0� ��ereby. <br />-r-- . /��--• <br />� ��"I � �.I � / C.� <br />OF <br />1 YEAR CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORECONSTRUCTION <br />,� <br />