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""re" APPLI�CATION FOR PUBLIC WORKS PERMIT � <br />� TYPe or print cleady �.n�h ink SOZ ��/ <br />PRESS HARD • YOU ARE MAKING COPIES pERM1T NO. <br />PUBLIC WORKS �//`��� <br />EVERETf, WASHINGTON E�LDG. DEPT. NO!"�._ <br />❑ OWNER ❑ AGENT DATE ���-.��2- <br />APPLIC�,NT/FIRM REPRESENTED_��i/C� `� ��L!� `�U� �� <br />ADDRESS ��� !�� C�/� v� a I� CITY ��TELEPHONE <br />�] ������� ������i <br />HEREBY APPLIES FOR PERMISSION TO �„L1.IL(d�U I� � r n�' �O � Y�_=a_.[1N� <br />�7 n i� /=� `� -1 �r - / i -- �---� <br />AT THE FOLLOWING LOCATION <br />-� �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. ` Topographic chznges requiring cuts and fills <br />' Outline 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 />' Csnterline of abutting right of way. " North arrow <br />1 <br />��/. -���� <br />Signalure ol Applicanl <br />PU�LIC WORKS PERMIT <br />CONDITIONS: <br />i ._. '/li✓e ova/ �:�C'C'F�� <br />✓ <br />; � : : �c�F� � s ,�� �,, / b = <br />':;�. . : <br />:::..: ::::....:...:...: <br />...,.�:.., , .. <br />-� .;.... , , <br />_- - -__.;.._.._----_._._ <br />. .-. . . .-:-. . . . , . <br />;. ,. �.... , . <br />� <br />;.. , . .... <br />_._� .. . _. -,-+-- . . . . . . . . . . . . . . <br />�- - �-� . . . <br />E:::;: <br />l.___.-. .. . - <br />-- .`' �j � _; „ x,:'---` . S • � - � L- <br />' -� -z� .�- <br />PERMIT IS <br />EX°IRATION ''- 3•-�3 <br />�=�_, /1 �` ���u��� / /T ./��i/Lt=..I� <br />—�n � r'.� e? 7`f'" /� L C T � . <br />/ :.: <br />:,:: <br />.;.. <br />: : ::::::;.: <br />: : ;.: f::: :' <br />. . . . - - - � � � - . _ - - ---;-., <br />The undersignetl owner hereby agrees to hold and save harmless <br />the Ciry ol EvereU twm any ana an clalms lor damages, cost& <br />expenses, or causas of aclion ihet may erise because ot instelletlon <br />and maintenance ot Ihe improvement or oMer riBh4obway use <br />herelo applied lur and lurther agrees to remove seme upon nolice <br />irom ihe Cily and to raplace public property demaped �here�y. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� , i� i "U� ��� <br />SIGNATUREOFAPPLICANT DATE <br />YEAR pOST ON CALL FOR INSPECTION <br />259-8811 <br />JOF3SITE 24HRS.BEFORECONSTRUCTION j <br />� <br />