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_ � <br /> - . _.. _ _ _ --, <br /> everett APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPa or Pdnt cleady wilh ink / <br /> PRESS HARD-YOU ARE MAKING COPIES pERMIT NO. ��� � � � <br /> !— <br /> PUBLIC WORKS �" � `G <br /> EVEREiT,WASHINGTON BLDG. DEPT. NO.��S7ya�/_ -'� <br /> U OWNER �GENT DATE �'�����- <br /> APPLICANTlFIRM REPRESCNTED —!!�'e- C o:—� JL—�� <br /> f.DDRESS I S+� Z- v�'a'�'cL CITY�`�'ei'� � TELEPHONE 2 S1 ' 9`l� <br /> HEREBY APPLIES FOR PERMISSION TO �D/���'�"''�L� �"d��� ^�� �� U� ewS7'�N 6 <br /> �a�K (E+�i'f" ���!1 o/c'�e,..r c a� �-/ .�/ .Gf.�./'/�_ aiei�e ti:�y <br /> , <br /> ATTHE FOLLOWING LOCATION � � .T I /�ah�'e F,.t'rc � <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 /> ' Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when requirfld. <br /> " Existing and proposed utilities. ` Erosion control methods when required. <br />' ' Centerline of abutting right of way. ' Nort/'h� arrow <br /> ---r�-"-� C i ature o 7 ican <br /> PUBLIC WORKS PER T <br /> CONDITIONS: , <br />, � <br /> i � � �- � _ ' -�—! <br /> - -�-- -� � - �, � - -�--!--E -' , -;- - ~�1 -� � � i <br /> _ t ,�� . _ � .i -;-<< X1;�2_'_ , t _ '��' �asc- �, �, <br /> _- �---1-?- � -r �- �- -+- - -'-i-'_-_' �-.-_ `, ` <br /> i � �' -1-� ..- �:�:r �� <br /> !"- i �ip p�� I ' I <br /> ' _ 1 -� - � - -����`�i..-C. �{�o � rn--1 t/ _.��G, r � %j_ (J' <br /> I j' + ��� � I <br /> _ " _ ' _ �� —:. —� — �� _.i t ._�—'� —C'CiM.t.I LC"— _� . .. i ' ��I � — l f I <br /> «� <br /> i . - - a - -} - �'1. �-� - - ' '> i � ��' � � .�� i'�"� � <br /> � -}�t - - -r, a� -`_`-� �LF jtilr' _ �:� + .Le � , <br /> � I i <br /> , i � i � '� ��.r <br /> � _ _� i_1 _�._. '- -t-- � �t- -- !- - --'- i <br /> I �� �_ � _1_ <br /> -� - - <br /> -{ <br /> -a-• -� � -- - - _ - �-• -• i 1 i <br /> l i � <br /> � <br /> - � <br /> � - - _L.'- -�.IL . - . � - - • _' <br /> --{-, r <br /> i � ' , <br /> � 1 { -' - - --�-'--� - -- - - j-�- - +_. 1 <br /> i � , - ' -�--�- <br /> - -� + '+1 -- '-�-'- ` ' " i I� � <br /> i �• �c --; <br /> T_ ��• .i. .r- � - -'�- �- - � `i - .L. i ,,i � -� � -i �i-" � <br /> � t y_ y _ � y�_ ._:__.- The untlersigned owner hereby a8rees to �old and save �arm�ess <br /> �_ .� .-!_� IM1e l.ity ol Eveletl IPom any ena all claims lor dameges, cosis, <br /> , i � �_"�" _� � �-� � � I expenses,or causes of aclion ihat mey erise Decause ol Ins7alletion <br /> �T � � • �� e n d m a i n l e n a n c e o f ih e im pmvement or olher rigM�obwey use <br /> � � . � � - herelo applied for and lunher egrees lo remove Seme upon noiiGe <br /> - - - Irom ihe Ci1y antl �o replece public propetly Eameged ihereby. <br /> _' i , l� .�-" ��.;�?� �_ � � <br /> APPROVED OR ONSTRUCTION DATE ACKNOWLEDGEM NTOFCONDITIONS <br /> ' � ��1 � � �� i l� Z-- ��� L ` ��-� �L <br /> APPROVED AS CONST.RUCTED DATE SIGNATU APP ANT DATE <br /> PERMIT IS VALID FOR 1 YEAR '� CALL FOR INSPECTION <br /> POST ON }�259•8811 <br /> EXPIRATION JOBSITE p4HRS. BEFORECONSTRUCTION <br /> I <br /> 1 <br /> �� <br />