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�""rc" qppLICATION FOR PUBLIC 1iVORKS PERMIT <br />TYPe oi Prinl dearlY with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. �� � <br />�EVERETf, WASHINGTON Q BLDG. DEPT. NO. <br />OWNER ❑AGENT DATE _�_��___/�(J� <br />, � J � <br />APPLICANT/FIRM REPRESENTED __ / (L�,�1�%�%V�—�,_C�� � g�1 �___ <br />ADDRESS f� � Z� � e'��J � j� �� CITY �[����TELEPHONE 5,2—'7/,� /� <br />HEREBY APPLIES FOR PF�RMISSION TO �!� �1 �(�����c�.dJ( ��„[,llnelti �'�^,,.,��-r,�_, <br />. � <br />AT THE FOL.LOWING LOCATION <br />� <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 fiils <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 />' Centerline of abutting right of way. " North arrow <br />�.c01�,e � <br />�nature ol Applicri <br />coNoirioNs: PUBl.IC WORKS PERMIT <br />-,_�.:�r ��:�, <br />_ �r.;-;r �,- �,,:..� _. <br />t i-- ,� -� -� i-� I r'-; 1 i'- i <br />1�_..,�r �ii „ � i � <br />i=- --��I1�-;�'}il!'�' 1 <br />f�_. , ��I :. 't , �-� ' � r ,-I � �-. <br />f� i � � �'t �l �(Y �—r <br />:_� ��1-r i t,-� � I-'i--� ( I._.. <br />+ f <br />� r <br />I I..�,.� 1 � i i. i�I �.. <br />� � � � <br />j.- � - i..r..� !.�1 <br />�._,_�� 1..���-'i7fi1...! <br />� r . <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />-�_�{���.: <br />� <br />, <br />=j11; _, � � <br />� '_�_I � � .i.=.1 _ i , ! � , � i <br />}i " �1.� i i�i� i <br />� -?_I �ia- � i+�i.l <br />� f t-j ` - � ' j � I <br />r <br />i � y__ � � <br />� , -i-r � � tiL �l_ ,: <br />t � J._ 1 <br />. y i � _� i J � <br />� �-�-'. { J 4 7-�-( �--j �_ .... ....I , <br />i I <br />�l � �i- <br />f ._�. <br />� <br />; �i-�_ ' � <br />� <br />, � ; ; ;_:, <br />�'t�.i�f.� <br />Tf,�!_L'i <br />, <br />t�;_�:'� <br />--,_�,�G_,��; �� „f� , <br />� y __• . ._ __ . _. <br />The undersigned owner hereby agraes Io �oltl and save �armlasa <br />the Cily ot Everatl trom any ena au claims for Oamape0. cost4 <br />ezpenses, or causes ol action thet may erise Decauee of Inat�ll�lbn <br />enE maintenance ol t�e improvament or ot�er riphFol•w�y uee <br />hereto applied lor antl �urt�er egreee to �emove aema upon notice <br />from Ihe Ciry antl to replace Dublic property dam�pod t�areby. <br />ACKNOWLEDGEMENT OF/JCONDITIONS <br />YIGNATDUI EOFAPPLICANT��� 0 �7E ��� � <br />POST ON CALL FOR INSPECTION <br />JOBSITE 259-8811 <br />24 HRS. BEFORE CONSTRUCTION <br />