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� <br />� <br />�"j`�l APPLICATIOI+! FOR PUBLIC WORKS PERMIT <br />� I Type or priN clearly with ink <br />� PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC; WORKS <br />PERMIT NO. ���_ _ <br />EVERETT, WASHINGTON BLDG. DEPT. NO. <br />� O\NNER ❑ AGENT DATE � V�-�( rj _(�Z — <br />i <br />APPLICF�NT/FFR{r5-flEpRESEiVFEB �J�.l�(� � l �/J.I� <br />— -- _ _-- -------- <br />}i �� c�, ,,�, f <br />ADDRESS __�i��� � A —_.__✓_N���i�I_lS_��_CITY e���iS�( j__TELEPHONE��g3(1�� <br />HEREBY APPLIES FOR FERMISSION TO RF�I_�l.p _]�j(��_ __ <br />ATTHE FOLLOWING LOCATION _ _2g_�_� �J�jj'�''Ca'�__ __ __ _ <br />Attach five (5) copies o( preliminary plans for propoaed work. Draw to scale and show the following as applicable: <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. <br />• Existing and proposed utilities. ' E , control methods when required. <br />" Centeriine of abutting right of way. � o h a ow <br />-�– '�fll�!(yf'1�?�a'1 --. <br />PUBLIC WORKS�F�E <br />, , <br />-- . . _ _ _ _ � , <br />, ,- _. . - . . � <br />� % � �� - :�. � � <�!-_ _r :3 .� �� <br />� I .��, � r=,. � + -- _ _}-. t _. .__ - . .___-__�--_-_ :��. _ - , <br />, <br />_. . _ _ <br />_ <br />1-i� : $,-. : ,-• , , _ !-._; ._� . _ -- -, <br />�_ _ .i. <br />�; - -, �J.�, - I � - -. <br />� � <br />a`a�� <br />�T- __; Str r - • � - .-} ' :: ' . '- r . . f :-, _ . � <br />. , � 1, <br />�. _ . � . . . --� -�. - -} -�- , - � • • -. ' � �- - - -� �' <br />: � � ' i .- ' ^. .� i ; �-. _��t � � <br />� � � ;� �_t_ i - •� <br />r ; 1_ - . _ . .-_ . - t -T-t - <br />;_._ - _ <br />T- <br />� <br />- - �__ _ - <br />� • - <br />. .�__ <br />� � r ; ~r— r • r— -• �- - -• � <br />�.: <br />� ��_� � : ` �; } � - • � .- • <br />i ,-- ' <br />.. T ��1 i-•� _ . . .- ' - -� - - <br />_ ' _ +-� ._�----�-__ <br />_ : _ a_,� r-r _.1_. --- . . . . �i_� -' - - . . • - <br />. -:; - ...!_.. .. _ ._ _ � . <br />..� ` - , ... .. . . :: . - . <br />-- , <br />i, <br />� .- ._ - . _ _� <br />�� ? i f Thc undersi9netl owner hereby agrees lo hold and save harmless <br />-- } i-- - ,. t- - •: _ Ihe Cily ol Everetl Irom any ana au ciaims lor tlamagos, cusls, <br />'''"' - ,-' -, - - - Bxpense5, Or Cau5C5 0l aC1i0n Ihal may afise beCeUse ol Installali0n <br />��, T-r1_ � ��~ and mainlenance ol Ihe improvemenl or other rig�l-obway use <br />r � j '� '�?-' -'" ' helelD applied lOr and lurihef agrees t0 remOve SBme upon notiCe <br />i� - J� j �-� �-��'- -" - IrOm �Ile GI �nd !0 r2pIUCe <br />_._ , y public property demaBetl Ihereby. <br />APPROVED AS CONSTHUCTED - - DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPI RATI ON <br />ACKNOWLEDGEMENT OF CONDITIONS <br />SIGNATUREOFAPPLICANT DATE <br />POST ON CALL FOR IPlSPECTION <br />JOBSITE 259-8811 <br />24HRS.BEFORECONSTRUCTION � <br />1 <br />`� <br />� <br />r <br />