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—, <br /> ; --- .. _ <br /> I ' <br /> � """" APPLICATION F�CDR PUBLIC WORKS PERMIT <br /> I � TYPe Ur Print tlearly With ink <br /> I PRESS HARD• YOU ARE MAKINC COPIES pERMIT NO. �����b __ <br /> ' PUBLIC WORKS � <br /> j EVERETf,WASHINGTON BLDG. DEPL MO.',-_'.��= � � <br /> iES OWNER ❑ AGENT DATE _�i_��-�--- ' <br /> � APPLICANT/FIRM REPRESENTED ______�r`���g�7���-�- -------------- I <br /> I ADDRESS � � � 3 RA iN/(" I � ' � � CI'fY E V�_t�� T TELEF'HONE 1S� •h S n0 � <br /> �I HEREBY APPLIES FOR PERMISSION TO �.aD t�n r N n nM �n �X!S T��rr � <br /> �_�� � 6. DiiVl �(nfiS�L - <br /> i ATTHE FOLLOWING LOCATION ��� RAiiv/�II D�((��_ I <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: � <br /> I <br /> � • Property li�es and street identity. ' Topo3raphic changes requiring cuts and fills <br /> � • Outline and dimensions of existing and other than normal foundation. <br /> � proposed structures. • On-site drainage systems wiien required. <br /> I � Existing and proposed utilities. " Erosion control methods when required. <br /> • Centerline of abutting right of way. ' North Arrow � <br /> _ ,��� _,�f.��; <br /> � ' Signature of ADPlicant I <br /> � PUBUC WORKS PERMIT <br /> � CONDITIONS: I <br /> i <br /> � I <br /> � , 9 ' .:7 - .SZ ,(,'I.' �.t/`/)� T T�' ;�=%��,� 1 <br /> � ; <br /> � �_. ._. <br /> _ . ;:���l;i; � , , . � <br /> t f � - � 1 � � I <br /> , � { I <br /> "' '. i � ; ._ �... i ' � �~� � T I -�- -t -i--`- , !' .. <br /> . _... � - � _!_ � � � � � � <br /> -''-' Ii ' L __� 1. j _' Fi ���;i iii � 1-; i I i ! , ` � I � L1 <br /> _;_ . <br /> � � , � t ; }_ � � , <br /> Ii _ ( 1 , ._ , ; l � , � ri � � i i ` i � � . <br /> i �_�� .�,_. <br /> �- Lr J � , � 1 i .� � ! 1 � ,- - - �, - <br /> i � i ��� , i I . �� , � � ! { � _i _� ! l ,.1 ' ' _.I. 1 � ' � y <br /> � ' : ` <br /> � <br /> i � } 1.T i--{ -- � E I �--{- f �f � 1 ` i T.� I � � r � r 7 , + j-r-, ' -r *-e,. -r �.' . � <br /> r_..� � t�-. -1 r - { . ' '�- i � � ��'� � ..{ � � i I t . .� � L T � I � . <br /> i � � � _._� � �. �_.L* .I I .� � ...._ ' �. I_� l� � .� .il r I �.. I � - � I l E��-"� r-+_� ' I; <br /> i '�� _� — — a � �� - i � ,� i � rt-� , .-1 ; � <br /> . t i � - � ' � -1 ` � i ' � � i_ � i_� � � ` , � � 1_; � <br /> , � - 1 L � � � 'V� i � .� M1�^ , � . � , � <br /> ' ' � � j �_' � � � � � + ' � � _ _ { -:- � � ' .�i= : ' <br /> � , _ <br /> , .. , i � � j q 1� , �. � i � I <br /> � .•—L � ,�� ._ . � 1 � ��.l_ '... I �`� �� �' .. � . ��_... _- � , i---� l—f- �T <br /> . .'� .,...� � � T r � � , ... _ ..{.-{- I <br /> � 1. i + II 1 � � � � 1 � <br /> i i..+–�- ' , 1 E I , . , , � � , �1— <br /> Ii _: � 1 t ._. �, ��_ , :�.L _; <br /> � ' '�:: I I ;��f` , � �?� _i j i <br /> The unaersigned owner nereby agrees to hold end save �armlass <br /> � ( � I } �� r y � „ j�,. ( � Ihe City of Everett trom any ena au claims for dtmeqe0. coatG <br /> i f'��1 � � ' � 1.! eMpenses,or causes ol aclion thet may erisa becauee of Inatdlatl0n I <br /> . . end maintanance ol t�e imD�ovement Or other nqhiroFway use I <br /> herelo ep0lietl lor and lurlher eB�ees to iemove same upon nollca <br /> ' / / � Irom Ihe City enE to replaca public property dama0� �hemby. <br /> ---�� /��I<� / � � ' 1 . <br /> � � '/� � <br /> I A V FOR CONSTRUCTION ! DA ACKNOWLEDGEMENT OqCOND TIONS " <br /> � <br /> � � Z 8 3 -f c/ ' '����f/ � <br /> � APPROVED AS C RUCTE D TE SIG�T�I RE SJF APPLICAN DATE <br /> ! PERMIT IS VALID FOR t YEAR � CALL FOR INSPECTION I <br /> POST ON 259•8811 <br /> EXPIRATION— JOBSITE 24HRS. BEFORECONSTRUCTIaN I <br /> _------__ �_.. <br />