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\. _ ____ ._ _ .. . .. . _ <br />I <br />everett APPLICATIAN FOR PUBLIC V�/ORKS PERMIT <br />� TYPc �r Print clBatly wilh mk <br />� PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. _lP� � <br />PUBLIC WORKS <br />EVE ETT, WASHINGTON � BLDG. DEPT. NO. <br />' A�YICANT/FI�ENT DATE :�:�L 9�� � . <br />' M REPRESENTED i�l'.f��_�lL�[�✓F �/__- --- - _ —__----- - <br />A�DRESS ?�.�� Terminal Atienue _CITY �-vereLt T[LEPHONE ?59-3164 <br />� � / �`_"_—T <br />HEREBY APPLIES FOR PERMISSION TO �Jli1z/ �i�� '`' �= � � � - <br />J <br />ATTHE FOLLOWING LOCATION J"!.c�P�"n �7 �� �� � a rTU 1�`-�_ <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />t Property lines and street identity. ' Topographic changzs requiring cuts and fills <br />• Outline and dimensions of existing 4nd other than normal foundation. <br />proposed structures. '� On-site c�ainane systems when r<.quired. <br />• Existing and proposed ufilities. ' Erosion control methqds whe�i required. <br />* Centerline of abutt'ng right of way. ' Nort afrow ,• <br />-�i`���� ���--� -- <br />9 gnature ol Appliwnt <br />PUBLIC WORKS ?ERMIT i <br />CONDITIONS: <br />�3��/�/� `2t/, ��, 6-e �����-.,�,���%" � t� <br />Gti. L �� �-c� r d� �� . <br />: �� iZT 1Z� i- VSC- S -ro � r� s i�z� (�.�'-L ✓k1 �.�S <br />la� �t1a-C- �{ W EQC-P� 'T S UR E u�-FE-1Z� -rl�Y' <br />�//� �� WE�E C�D�n1Cr T� ��X/�c.L ��� 1���Q';'�'�' <br />h � <br />/ � � � Ci � � . ^. \� � � c' � � / <:it_�_� .-G� �-+E_._ . --5 �- � t'� <br />�. , S / � J � .�U CL��J ��—N/✓.1' i /� <br />. � f',:�/C.� _ �LS y, � �,�'r/_-'..i •� �z�.�,[�1 .F'C�,�c.�'C ,l,rC;�' <br />� <br />�_.E'_ �h`-�i.L�1_��`.F'cJ'. <br />� iG-�-_� � - i <br />i : -�� <br />�ERMIT IS VAL <br />��-.XPIRA710N <br />The undersigned owner hereby agrees lo hold and save herm�ess <br />Iha City ol Evereu trom any ana an Geims lor. dxmages. cosis, <br />e•penses, or causes ol action Ihal may arise because ol installslion <br />antl ma�nlenance ol Ihe impmvement or o�her riph��obway use <br />herelo apUlieA lor and lurthe� agrees to remove semo upon notic� <br />from �he City nnd lo replace puhlic property tlamagod Ihereby. <br />ACKN G�kEDG MENT OF COND�TIONS / l <br />y, <br />j� / //J,!�'L <br />, <br />5'�GN T f;�� � P LI AN . DATE �_ <br />CALL FOR INSPECTION <br />�OST ON 259-8811 <br />JOBSITE 24HRS.BEFORECOMSTRUCTION <br />