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everctt APPLICATION FOR PUBLIC WORKS PERMIT' <br />� TYPB or Print Clearly with ink <br />PRESS HARD • YOU AAE MAKING COPIES pERMIT NO. �� `� `� ��� <br />PUBLIC WORKS <br />EVERETT, WASHINGTON �-j i BLDG. DEPT. NO�d �O '� � <br />❑ OWNER ❑ AGENT DATE __! -�—� �!� - <br />APPLICANT/FIRM REPRESENTED _`? '���`, -�==-�' -- <br />�___ <br />ADDRESS S� 3 `�`�¢s`�- ��I�CITY ��' � _TELEPHONE 35 3' 3`�(� 1 <br />HEREBY APPLIES FOR PERMISSION TO LCti S i r C-Q � c.^ �- v V�-� � N�1STt t� <br />c�ov�c. S1o�� <br />- ��3 �G�� l.Ua <br />AT THE FOLLOWING LOCATION <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. <br />• Outline and dimensions of existing and <br />proposed structures. <br />• Existing a�d proposed utilities. <br />• Centerline of abutting right of way. <br />' Topographic changes requiring cuts and fills <br />other than normal foundation. <br />` On-site drainage systems when required. <br />' Erosion control methods when required. <br />' North arrow <br />Signelure oi Appllcanl <br />coNoiTioNs: PUBLIC WORKS PERMIT <br />. , -; , - ; <br />, <br />' �` t ' , ! . . r �" ,l: ' , � �.. <br />, : �! At�� ��� u1 y' �%;.�,T��51 c.��a ; 1;��.°ti%� � i 'a�' <br />- .— <br />__ � <br />(� ' : ��``Tt" � ��L� :; �- t ' ._� a � :! .''-1. ;.L' � :-�1=-� " � � +' �_t _(�, 1-. : <br />!� <br />� � �-�--� ' �� <br />.. . , _., <br />� +_� � (.ii �I �, � � � � � � (, I i I-r j _ �.1 � _! � y i. � �.� � i__I j � � � i I I-�-' <br />� ! <br />��� ���F��;�.._�����;.�_� ,�i ,�r,.�, ; i�,. �__i � ��1+-'i-.-� �' <br />i , , , i � _. _ Li._�t._ i _ �:L, �. _._ _j _._.-�-�- . , .-, -, <br />� ,_:_� , .. .� -�. <br />' , <br />. I . _t.. -:_�- �. 1. <br />i i <br />�_. � � ,. ...._.... <br />(0 <br />PERMIT IS VALID FOR'1" YEAR <br />EXPIRATION <br />� <br />t����-�t+�-�. <br />, � � <br />� , _.{.;-t-- ri ; + <br />�:�J.1� � <br />, � <br />� _: _ <br />�.�.' 1 + 4'= ._ <br />� �.! � i ;._: <br />j_ T i t�; t�.r_ �-: <br />��_i�_.: i_. . � 1 t 1� ,�.. �. <br />�1 ... j `I_! ' � ' ; ..:_ ' l � 1 ..J 1 <br />! j, ��... The undcrsiBned owner Oereby egrexs to hold end aave hermleba <br />..., �� ihe Cily o� Everett Irom any en� all cl9lms lor damepe4 con10. <br />erpenses, or causes of action Ihat may erise becauae of inat�llatlon <br />entl meinlonence ol t�e ImOrovement or other ripht-ol-way uee <br />� �ereto applied lor antl lurther ngrees to romove same upon notice <br />/ Irom l�e City and lo mplace public property damapad ihereCy. <br />' z. <br />ACKNOWLEDGEMENT OF COND�TIONS <br />�7 7 <br />'�jj r <br />/[/ i,/��LU- i . <br />SIGN7T E OF APPLI � N DATE <br />CALL FOR INSPECTIUN <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORECONSTRUCTION <br />