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` <br /> 1 <br /> -' -�� ------ _ ------ - <br /> - -- - - ----..__..._ - - <br /> � <br /> e"e"" 'APPLICATION FOR PllBLIC WORKS PE�RMIT <br /> � . TYPe or pr,nl cleady wi�h ink /' <br /> PRESS HARD-YOU ARE MAKING COPIES pERMIT NO. �LL.��— <br /> PUBLIC WORKS � <br /> • EVERETT,WASHINGTON BLDG. DEPT. NO.— — , <br /> ❑ OWNER �AGENT DATE ._��� 8/— <br /> /kPpb16AA4T/FIRM REPRESENTED �����-��1���----- - ---- — <br /> e � <br /> NDDRESS _.'�,1���� � —CIN � �f TELEPHONE�'����� <br /> HEREBY APPLIES FOR PERMISSION TO — <br /> _ G�tlliZr�/�'�� 1����=-=•�id '��- � <br /> I <br /> ATTHE FOLLOWING LOCATION ='"1`���-`���y1�%�.j-LL�` �`���=�-� <br /> Attach tive(5)copies ot preliminary plans for proposed work.Draw to scale and show the following as applicable: i <br /> i <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 required. li <br /> • Existing and proposed utilities. ` Erosion confrol methods when required. ' <br /> ` Centerline of abutting right of way. ' North arfjw � I <br /> � __��Ol!/f.���. ,/�CGI�C�lf� -' � <br /> _ � Signaturo ol Applicant �— i <br /> PUBLIC WORKS PERMIT 'i <br /> CONDITIONS: I <br /> � <br /> 1 . . . . . : : , : . � <br /> � '_: 1 • � : : � : . � : : �---- - . - _ : . . . _ . : . . . .-• - - . . . : . : ._: I <br /> � �' . '. . . � . . . . : : . t • , . . . ' : . ; - . . : : . I I <br /> ,_,_: �__ 1 - __� .. . _. ._ __� _ . . . . . . . . . . . , . _ . . , . . . . . <br /> I ' ; : ; . 1 : . : : . : i , � . . { ' . . . . . � � ' � : . � . . <br /> � : . . ti . . . . . :- - - --- = - - . .__ _ : -�-1-�-+_ _ <br /> � <br /> . � ` .��.� • : • • : ; . ' ; . . : ' . � : : , � : : � : : : <br /> ��----� � I ': ' { . : t : i l . . ` : . . • � . . , . . . . � . <br /> , ' <br /> �.. : ' : : . . � : ;�-r------fi- -�_. ' i_._. i <br /> 1 - : • r' � � <br /> _�;.�.�__�_.._�_____-.-•—. . <br /> �'--�`- The undersignotl owncr horeby a9rees to hold and save hermless . <br /> '� ' ' ' ' i ' ' �� � � � � � the City ol Everell �mm any a�a an clalms br damaPes, costs, ' <br /> ' ' � � � � , , . , . oxDenses,or causes of action Ihat may arise because o�Instellalion . <br /> �� '� � � � � _ . . . . . . . . . . qnd maiNonance of Ihe improvemenl or other rig�t-of�way use <br /> � . . . � hemto epplied br and lurlher ag�ees to remova same upon notice � <br /> Irom �he Cily end to replace pu6lic property damaBad ihereby. � <br /> I <br /> �_ ______�_Q.��O a7G �� �' J <br /> PPROV��R CONSTRUCTION I/�T �ACKN9WLED EMENT OF C DIJIONS j <br /> �� �/�1��.�C71 ��%�9/�/////f.�� � <br /> ' A�OVED AS CON UCTED DATE SIGN TURE OF APPLICANT � � DATE' / '' <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION I <br /> PC�T ON 259•8811 i <br /> �� EXPIRATION JOBSITE 2qF;RS. SEFORECONSTRUCTION ' <br /> r <br /> - - - - <br />