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i:+ <br /> everett APPLICATION FOR PUSLIC WORKS PERMIT <br /> � TYPe or Print clearlY with ink <br /> PRE55 HARD-YOU ARE MAKING COPIES g� '��f��' <br /> PUBLIC WORKS PERMIT NO. � _ <br /> EVERETf, WASHINGTON (� �7 BLDG. DEPT. NO. ��� "—� <br /> �OWNER ❑ AGENT DATE �O _��/L+ O�- <br /> � <br /> APPLICANT/FIRM REPRESENTED _ _C%S�ZS����J� � — <br /> ADDRESS �����/'�� CITY / i/ ��TELEPHONE �^Z' ��C�7 <br /> HEAEBY APPLIES FOR PERMISSIdN TO _��.�a�% � C <br /> ATTHE FOLLOWING LOCATION _._r c�_L._/��� e �-LL r <br /> Attach five(5)copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br /> ` Property lines and street identity. • Topographic changes requiriny 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 when required. <br /> * Centerline of abutting right of way. ` N h row ,� p <br /> %�_���.��� � -Z9'�Z <br /> Signature ol Applicen� <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> � �J <br /> - - - , i <br /> - - - - - - -L�- -, t-�- - � � -� _ _�__; i � <br /> � i � � i <br /> - - � - � � � � � - � � <br /> �;. � <br /> � ��_# i � <br /> �� � �y � <br /> i _,_�_�" _*_I- � <br /> , - � i <br /> i i i, i _j__ `y , i � , <br /> � - _-1� I.�_ I � � �i� �--� �'�� � 1 �r_J_.! I i � �� <br /> � � I � <br /> . . ' . �.r_ � +-1. �-� � <br /> - ♦ ' - � - � I I I,� -t � t���}7 _• ' i � <br /> 1 �-r- L- - - } 7 ' �.-�-�1 -� <br /> _ . _�1 _ �. � ' __ 1 J y._ _�}_ . f —:-�1- — l. _�--.—�-� <br /> ' -�1 - . 1-� - � _"-'�. 1 y.�..� .� : 11 -.-_:_: -:1- � -.-.i 'J <br /> -,--1-` � -, :� . . i t-: ' . J <br /> __L _ -�--1- - ' • -'--�- r� _.-{ i - . <br /> � , � i <br /> �� i i -� t ! _� _;_:_; .-L . :� . 1_' - �-�-�—� �. <br /> �_: 1� r T .}�� . _ I-: , <br /> � 1- , i � . - -L l - � ,_ . : _ _� . _ . _. _ � <br /> � , i i i--;"i ' <br /> ' � � I {.;.+ r.. . . _ 1-� - � _i_.' ' The undersigned owner hereby agrees to hold and save�harmless <br /> - �-i � i , r�! }..� { ---{- .1 _ �he Cily ol Everei� Irom any ana all cl9lms lor dameges, costs, <br /> - -1-1 � . • .-- -«rt-� ,�.+ .-� expenses,or causes ol adion Ihat may erise because ol instellation <br /> « �--� �--�-� ., I i-1- , i and maintenance ol Ihe improvement or other righPol�way use <br /> _� ��- -�_1 1 . . --y- -�.--+- i�--�-1-� hereto applied lor and luriher agrees la remove seme uDon notice <br /> '-'- �-Y�-t- 1- � - - - - - Irom Oie Cit antl to re lace ublic roperty dameBetl t�ero�y. <br /> I J Y P V P <br /> `_ _ ` /7/-��- J <br /> APPRO�D A3 CONST 1 RUTED N � AT��� S��E�L CANT��I� DATE __ <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTION <br /> 259-8811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION <br />