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everett APPLICATION FOR PUBLIC WORK � PERMIT <br />� TYPe or Pdnt cleaity wilh ink � <br />PRESS HARD - YOU ARE MAKING COPIES pERMIT NO. _.�G�-.Z �� <br />PUBLIC WORKS � <br />EVERETT, WASHINGTON BLDG. DEPT. �O. <br />I'�OWNER ❑ AGENT DATE _. Z/�/� '___ <br />APPUCANT/FIRM REPRESENTED _---�n/?l __.G_r'__ �4;�.�z/-- 7! --���-iG�:.r%/y��<-/��v� '�"�Z, <br />ADDRESS �zl_.-S�,cW�_,(,,__SU�T1� Zoz� CITY FLJL�'Nn_—TELEPHONE77_ -5'3�'`3y, <br />HEREBY APPLIES FOR PERMISSION TO — L��Sf P�' PS � L �a �_ — <br />ATTHE FOLLOWING LOCATION _ _—_--. - — — <br />Attach five (5) copies of preliminary plans ior proposed work. Draw to scale an ] show the following as applicable: <br />* Properiy lines and street identity. ' Topographic changes requiring cuts and filis <br />' Outline and dimensions ot 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 />' CeNerline of abutting right of way. ' North arrow ���� /�fy,�,, <br />� i1 t l f%t_llL�s� ��-An_�_ .— — <br />SignaNre ol Applicant <br />UBLIC <br />PERM17 <br />I � i 1 � -_h 1 . _, _ } . � - { <br />l_T 1 , � �_ • � . � . . i <br />� �,�, ' _ ~ ; <br />-. _' . ,�j�T � _�'_ t tL.�' �1 ���Gt � Z� ' <br />L J� �-�4 � <br />I 1/rC ,_� _ � J.'��- _ � ' .C'_i � ..�. � - i •� �. • � � . � <br />_T'� • ' .�. ' ` ! _ .. � , . . .. ... . . _ _� . <br />� r j _ 1 -� <br />_:__�1' _.�1_1- . .-:-�-�'� , � �"� # ._= r _,--,_�-. --t-' + i � ._�_ .�- - �- � <br />Yv � :_� <br />! • <br />f- - -'-� <br />PEHMII' IS VALID <br />EXPIRATION <br />R1 <br />;_L, -} --�- �-',-' ^ -!-=-{- -�-� <br />_� J ---� <br />_ ._, i _, i . . <br />�� y- � � � I -« L - ? � i -! . . <br />-�-r . _. ._. �__.1 . • r . _.� I <br />J _H . - • -� . • -�_ _ t . � . H �--L ^ -f� <br />�_�_�� _ � <br />t . , i }� �� �� -, '�__. <br />_ _ .-, - <br />_'__ j_ _ . _'; _.. ._ ... <br />. _ <br />. . }._. . _: � ._, - -- . ...._ : _. <br />• _ ' I_'_ �_' , - -. i <br />The untlers�9ned owner here�y agrees to holA and save �armless <br />iho Clty of Eveiell trom any antl au c�alms lor dnmages, costs, <br />eanenses, or causes ol nclion Ihal moy arise because ol inslella!ion <br />untl maintonanco ol lhe imp�ovemenl or othor righDo4way use <br />herulo applietl for and lurther ayrees to rert�we samo upon not�ce <br />Ilom Ihe Ciiy and �0 lCPlace public pro�crty damaqed �hereby. <br />ACKNOWLEDGEMENT OF CONDiTI0N5 <br />��.>� �GiZT Gi' ��;-:a=T% <br />� CALL FOR INStPECTION <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFURECAIVSTRUCTION <br />� <br />