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��«°tt pppLICATION FOR PUBLIC WORKS PERMIT <br />� TYPe or Print cleady with ink O�� �O ! _ <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. <br />PUBLIC WORKS BLDG. DEPT. NO. <br />EVERETf, WASHINGTON I� .� I <br />❑ OWNER �AGENT DATE _��-J-1— 4 i �U��� <br />APPLICANT/FIRM REPRESENTED C�I�.i^`Ir -C�,-���2 Z'. _���'� <br />ADDRESS <br />�� �� I�'1���� I`tCb I�lV�1. CITY� �-- TELEPHONE ���- �bO <br />.�_.-� .,—.�, , , C I�r.-- ��inf/.Ic:. ,4`� <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION .� e1 '-� '" "� '—' '-�' " �1-- • <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 ot abutting right of way. <br />� <br />CONDITIONS: <br />' Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-site d��ina�e systems wh�n required. <br />� Fmeino�nnntPol method�hen required. <br />. <br />-k1����- <.�\ -�`�1 lacr� -�� cv�ken� <br />i_ i�- �5 �<«...w.C�,�l�<� � P(' <br />' �,. <br />���er�« n.,.J�' cb_�nc�-�c„ ' <br />CUv�7�('fNC��IJ•'1 <br />.� <br />b� \���b -C'ti- pry��� m� <br />IIC."..tDral� C�o��3 �at%o�aa,'l�,f / � <br />{7 ti..'�w� ���iS cs..,Y� ��[�<��MP.� ���11 b< ��br�� n�� <br />a, ro�e� -Ecn-�1�� ' S . � � <br />1 �.(. k-� -lr,..�ks �s �I�I,�N���� �� �,.. ,�� <br />..4-i;n e4 w ke., ever a �� c or <br />Uu,',' ma�et'�n�S . /� <br />�j ^ ,,� �/ I 1l. ��.c�ue�..,..',4'— P�nns a� <br />'J �i�l �Naif.� 4��t\�� bC .i['1 (Mfa:" IJ1 (.CiC4� Ln�M1(C ✓• <br />Y � / 1 <br />C' �- �.' n4 E.i�rtrf�' �'��Snw..� �n1Viu �-•� <br />�`iPro(�t� 11-3-'{'L a�..�✓ C.���r-�+ <br />S�:.Jlardh c -.J Sf1te.�` iee,--iiu.+j <br />1 <br />lca,v F/����d iN a� m i» �_�. <br />- ,-{_ <br />� .—�-1-_i_ . <br />PERMIT IS VALID FOR 1 YEAR � <br />EXPlRATION � " ( - �'� <br />s� <br />Tho undersigneA owner hereb)'agreos lo ho10 en0 save hermleas <br />Ihe City ol Eve�ett �mm eny ena au clalms lor damepe& cont0. <br />expenses, or causes ol adion thet may arisa because ol inaldletlon <br />end mainte��ce of the impro�ent or olher rip�4ohway uee <br />�crelo a �ed lo� end lurther eg s lo)mmove same upon nolice <br />Irom 11�City�antl lo replace public p�operty dame9� �haroby. <br />POST ON <br />JOBSITE <br />' CALL FOR INsr�tc: � wrv <br />259-8811 <br />24 HRS. BEFORECONSTRUCTION <br />F <br />� <br />C7 <br />H Y <br />H <br />r� . <br />� � <br />� r <br />� � <br />� f: <br />� � <br />� <br />b : <br />C' � <br />i-+ - <br />y ,. <br />K <br />rT �". <br />�,' <br />�7 . � <br />(] ' <br />� ; <br />�Z <br />�3 : <br />