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� <br /> � <br /> "'"�" APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYGe or Orinl clesrlY with Ink <br /> PRES3 HPRD-YOU ARE MAKIN6 COPIES pERMIT NO.� 3 7 � <br /> PUBLIC WORKS '/ � <br /> EVERETT,WASHINGTON BLDG. DEPT. NO. �� �� s7 <br /> �OWNER ❑ AGENT DATE �Z'"i�'8'L <br /> APPUCANT/FIRM REPRESENTED I t(�0.�n s' I�QM GV �� L <br /> ADDRESS 10 �,[ r��l'�C- CITY G��� �N'3TELEPHONE �J� <br /> HEREBY APPUES FOR PERMISSION TO �[` l� a ��� � u`� ( ���Uei^-U� <br /> Y � Wetit Q���iv+U ���� {'✓�oOCr�� �G /�Px <br /> ATTHE FOLLOWING LOCATION ._�aaO � � <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 fills <br /> ' Outlfne and dimensions of existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> " Existing and proposed utilities. ' Erosion control methods when required. <br /> • Centerli�e of abutting right of way. • Nort a row <br /> Slaneture ot ADP�� ant <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS; . _ - -- - - _ . . . . . - <br /> 4 . . . 1 . . . ; . . <br /> . �. . . .. . . . k�CCC7� ,"t� . . �4Y . .'�o . .bf . �..,. . A I(P /-�. no. v�r w . . . . . . . . . <br /> � . . . . . . . • o �,q�t.�� Si. `oc��...;���Y <br /> . : . . . . . . d r�v e,�..�w N . e•�:'� � . -y� . . . . <br /> ( � r , <br /> l _�.-_- . -�I � •p'\, G,���1cnbG . SPcr�u �t .nw�� �5��15 0l- �t 1�•�b��c wc.-�as �C(��7 lr5ifn . . <br /> • . Iy /' / � <br /> � • t ' /� l� t � � /� 1 S�lA . . . . <br /> � . . . } . . . � . pwY. Ga.�s•P"uhu.. . �'�w..J�w..X7 4�^.. �Cte.'Ii�n:�.e.. // �Jf 7n/�Uw/ . . . . . . . <br /> �__. ._.�_L-_-.._. r . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> � ; . . . . , . . . I � ' . , _ � _ .... . -'-- . .. . � . . . . . . . . - 'T: � � ,--_ ' . <br /> — _• _-�-- - ---- —. �, �- ---t — �. .� ._•_1-' . . <br /> -' � : { � � � � . . . . . . . . . � . . . , . . � i <br /> , ' <br /> . . , . . . . . . ... ; , . . • . � . . . . . . � , . <br /> . . , . � . �I . 1 � . I . . 1 � . . . . i . . � . ' . _ . _ { ' _ . . . . � . <br /> ._��. : . i� .�- ; --- -}----,-_---- . . �� T � . . . . . . . . : <br /> � , ,AGw. Cd� .p�'�S,r��•"^�� . �'c"'�S•���� Q� �'/h � Tha undenigne0 owner here6y aqrees to holtl end esve hermless <br /> , , , . , . . . „o . rX,yfi,.,a c�a,..n��-�+los f..k•ti �71=�Fi the City of Everett trom any ana au cuime lor d�maye4 coat0. <br /> ezpenses,or ceusea ol aCtbn Ihat may arise because ol init�llation <br /> I : :R.f9��; _q�k� � n�„y� �,,,,,,��,}�;,,.. . . . . . . . . . and maintenence of,lhe Improvement or other riqhPohway uee <br /> hereto aoPlied tor and lurther aqreas to remove same upon nolke <br /> � � � . . . � � Irom the Ciry and to reDlace pu6lic Oropai�y tlamaqed thereby. <br /> � ✓`��Z �"2— � <br /> � / OVED FOR C� 5��'' /' DA E ACKN/�O LEDGEMENT O/F�fONUITIONS <br /> � s�i���9' �i Fj T� .�— P`/� /��4 8.L <br /> PROVED AS CONSTRUCTED DATE SI A URE OF APPLICANT ATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> ' JOBSITE 24HRS. BEFORECONSYRUCTION <br /> ' � EXPIRATION <br />