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�1 <br />r <br />r <br />r <br />� APPLICATION FOR PUBLIC WORKS PERMIT <br />� Type ar prml Uoerly with mk <br />PRESS HARD • YOU ARE MAKING COPIES g�1/3 �� <br />PUBLIC WORKS PERMIT NO. _�� <br />EVERETT,WASHINGTON I c <br />❑ OWNER �l AGENT DATE �I � Z F� Y BLDG. DEPT. NO._p.1/ I I.�,3� <br />APPLICANT/FIRM REPRESENTED Hia2GJ.� GUT. � <br />1 ti� • <br />- ----- <br />ADDRESS _(�,3L% `� T� �-C_--_ _. 32s - G � S U <br />- ----. ._.___CITYSE��� _TELEPHONE �3 �_=LE��3 <br />HEREBY APPLfES FOR PERMISSION TO _�u.�p _�/e�_ ��ES�_p�rVGF _( o.E� <br />(Y�/�_�./YILS._�RUG _�AJ_�E'� �__Ow,U�•C5 , -- <br />AT THE FOL�OWING LOCATION IQAG�T� % j}�1q'�l.t- �6i4N i_S._�� ��� �/aL_!U _�61_sj_ <br />Attachfive(5)copiesofprelimina /"' l � M`������a '8��q. <br />ry plans tor proposed work. Draw to scale and show the following as applicable: <br />• Property lines and street identity. ' Topographic changes requiring cuts and fills <br />' Outline and dimensions of existing and otF�er than normal foundation. <br />proposed structures. • On•site drainage systems when required. <br />• Existing and proposed utilities. • Erosion control methods when required. <br />• Centerline of abutting right of way. ' North arrow <br />c_`y�w.Y !C^���� � <br />�r�Y Sign.� :u�l Applicant <br />coNoirioNs: PUBLIC WORKS PERMIT <br />, <br />a � e i S -� b� �—�-K k r r N1 o� <br />l'i�1JTlv� 5�b(JG �JN'�Ptlrt�� <br />1 <br />a.bo..,c -{-�:s bH,ld�,..` : <br />� ; �-e. . <br />'� C1 � 5't u. rVj <br />`i-�• C ('1 a v"` � <br />/r�� L✓nn.-� S�a1// 6t �Pr�o..n��Y.n !lc��7.��ric a...��i i�fif PN/.�+..T <br />4Mll ('µ�iMT �/y aFEK�.<PN y.�Sisn w'r.���W�kG�lc��- .5��✓qirff <br />w..c�s�l c. trc��o�r . <br />���'. . , y /<��c-��. <br />�� c�-} �e�o�' � ,,: ,«i � ��a-� <br />Q,�c1c . c,l�c� <br />A��V����%-�Z <br />� DATE <br />� � � � �� -i� ��� <br />OVED AS CONSTRUCTED DATE <br />rtnm�T IS VALID FOR 1 YEAR <br />EXPIRATION <br />Thc unticrs�gneC owncr �ereby ngrcos lo holG anU seva �armlene <br />t�e Ciry ol Evere�t imm any ann an claims lor tlamepe4 tosb. <br />e�penses, or tausos ol aclion t�al may erisa Oecauea ol installeiion <br />entl malrtenance ol I�e improvement or olher riqhtro4wey usa <br />he�elo applied lo� and luriher a8�ees to remOva same upon n0�ice <br />Iwm I�e City antl lo re0late public proparty damaqad I�ereEy. <br />ACICNOWLE GEME T OF NS <br />SIG ATUREOFAP ICANT�— DATE <br />POST ON CALL FOR INSPECTION <br />JOBSITE 259•8811 <br />24 HRS. BEFORE CONSTRUCTION <br />� <br />+� <br />1 <br />� <br />J <br />L <br />J <br />