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.` <br /> . .. i <br /> everett qppLICATlON FOR PIDSLIC WORKS PERMIT <br /> � TYPe or Print tlearly wiln ink <br /> PRESS HAR�- YOU ARE MAKING COPIES 8�a 3 G <br /> PUBLIC WORKS PERMIT NO. <br /> EVERETT, WASHINGTON ���p��(� <br /> Od OWNER [7 AGENT DATE � � JL���J �/,�f�' BLDG. DEPT. NO. _ . <br /> APPLICANT/FIRM REPRESENTED I�OG`��L2S �• ��J-(�C��L'�y <br /> - - _ . ._. ._.__.__ . <br /> ADDRESSLG—L�'__��G_'��C�f"'�1/�` —��_�'____CITY ,�_�'�J-L��TEIEPHONE �'�� � �f � � <br /> HEREBY APPLIES FOR PERMISSION TO _ _(Lf_L—'��7 ST�_�/A __fJJ-Ll���.✓ tZ`j <br /> / --�— <br /> �✓�z,�7� _ _-- - ---- -- <br /> AT THE FOLLOWING LOCATION I�l�c(: /J�GCr)_.L�f—�//21-.__�yC• .L' L�rG�� hY'.�.1�_ <br /> Attach (ive(5) copies of preliminary plans for proposed work. Draw to scale and show the foliowinc�as applicable: <br /> ' Properry 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. ' Erosion control methods wher. required. <br /> ' Centerline of abulting right o( way. " N rth arrow <br /> � 7 '7-� _ <br /> , � <br /> � ��i�. .�_�C_ �L� <br /> S ynalurc ol Applmanl t � <br /> coNoirioNs: PUBLtC W013KS P�RMIT <br /> ;, <br /> , <br /> ,� <br /> . . lhr vn�cis�gned o�wn�•� hcreby pt�rces lo M1old 0ntl 5avo h3rmle55 <br /> �hc Ci1y ol Evcre�� nom any nno au claims lor damagas, eosis, <br /> eepenses,ur causns ol ac�ion Iha� may arise betau5e ol inslellatio� <br /> and maintonance ol Ine imorovement or othcr nBh4ol�way use <br /> �1 hareto apphetl lor and furt�er agrees to remove samo upon notice <br /> from ihe ��ry and to replace public property damaged iheraby. <br /> _ . �� ;� IzI ' <br /> � <br /> OVED OR Cb STRUCTION TE� A NOWLEDGEMENT OF CONDITI NS <br /> -- ����(' �� � ,�,� � �,,��� � � �,/,.;� ���,� ,�,�.��� �� �� <br /> L� �-: - :�-- - - - - ---- � <br /> ApPROVED AS CONSTRUCTED DATE SIGP URE OF APPLICANT % D TE � <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 25g.gg� � <br /> EXPIRATION .-. JOBSITE 24HRS. BEFORECONSTRUCTION <br />