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'I � <br /> i <br /> evercn APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Print cleady with ink � <br /> PRESS HARD -YOU ARE MAKING COPIES pERM1T NO. ��71 <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON BLDG. DEPT. NO._����>_.Y�� ._ <br /> ❑ OWNER [�`AGENT DATE .��3a�f_�—_. � <br /> APPLICANT/FIRM REPRESENTED C_�OIJ_lhL_<�_l.(.S_I"_Q(1� __I'IJt�?_FS_1_�SI_C... __—— <br /> ADDRESS �� •; S_ (�<C-Gf]IZ�J�� CITY �A�1If TELEPHONE .�S 3 '(:t�un <br /> HEREBY APPUES FOR PERMISSION TO I�I Sj�—CI(;S,j1L.L(,—Q�iWL'4vl�i — <br /> ���__ <br /> ATTHE FOLLOWING LOCATION —����--.�oCw�P�C IIf'/_ <br /> Attach five(5)copies of preliminary prorsosed w ro k. 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 req iired. <br /> • Existing and proposed utilities. ' Erosion control methods when required. <br /> • Centerline of abutting right of way. ' North arrow <br /> � � .� <br /> —�.S�i/�"S)N — <br /> Signalur 1 Applicanl <br /> ry coNoirioNs: PUBLIC WORK^a PERMIT <br /> � <br /> �� <br /> �l; �� M�s < < <� J�-� P ��P�„� o � �e ����y 6.-fl,�� <br /> << / <br /> JIGIt' W�'�L ao 7'tn-f �JGL�t' lS�4G��O✓. dt� V�W� <br /> � �..�.b1�c Wa ��S _�Lv+S/� e��r � s re�j �t�i�.Q <br /> V ( <br /> �' �'(�Ut "� 3l �r - O � ti { WO ��• <br /> \h <br /> �i ^ <br /> � <br /> T � � �v{/v v ` /1 L1i/11 "— (,(/�p'� <br /> � CiV'"� \ <br /> r,� � � 1 r <br /> � ^ _ � <br /> � � �� ����� � � � ������ <br /> � � <br /> e u � igned owner hereby a ees hold save hermless <br /> Ihe j ol Everetl Irom any nno cl ims 1 r ameqes, eoals. <br /> e en 5,or causes ol action tha�may erise bac se ol inelailation <br /> nd ainlenance ol the improvement o� olhar rig�t-ol�wey use <br /> ��here aOPlied lor and IurNer egrees to remove seme upon notice <br /> �. hom Ihe Ci1y and to re0lece puhlic propetly damaged t�ereby. <br /> ��7 if� �-�"�' .3� ; <br /> / PP OVED FO C UCTION DATE �' ACKNOWLEDGEMENT OF CONDITIONS � <br /> � � � �� �y i, - <br /> �I� / / . ', i / �U �"� <br /> A uNic �SIGNATUREOFAP LICANT � DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR/INSPECTION <br /> POST ON 25g•gg11 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION <br />