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i <br /> - -- -- <br /> --- -- - - - _ _ � <br /> "'°rc" APPLICATION FOR i�UBLIC WORKS PERMIT � <br /> � TYPe or Vrint cleady wil�ink � I�i <br /> PRESS HARD•YOU ARE MAKING COPIES pERM1T NO. ��� <br /> PUBLIC WORKS I' <br /> EVERETT,WASHINGTON / BLDG. DEPT. NO. I � <br /> ❑ OWNER L�AGENT DATE ����5 � <br /> I <br /> APPLICANT/FIRM REPRESENTED ����� •�-=���L��-�-1���--�+< `-- — i <br /> ADORESS %•5 /J I� •'�_c CITY —rv�r-P.i�_iELEPHONE iZ4 9'��.2 Z <br /> - • <br /> HEREBY APPLIES FOR PERMISSION TO � 6 �i-/ ✓ /.�- s <' .^1 r^� ' _`- ,-*� v `� 'j i"' : � <br /> ,_/ �" � � ��� ' <br /> :YL�� .:�o [cl i < S i.�1�_—.l �v r' ""/ .a. ' .i� ..-� s .i _ . <br /> � / I <br /> �? <br /> AT THE FOLLOWING LOCATION � `/ F�'� ?"'� � ��✓ "" �='�=� , <br /> 303 D ' <br /> Attach five(5)copies of preliminary plans for proposed wor raw to scale and show the following as applicable: <br /> ' Property Iines and street identity. * Topographic changes requiring cuts and tills <br /> " Qutline and dimensions of exisli�g and other than normal foundation. � <br /> proposed structures. ' Omsite drainage systems when required. <br /> ' Existing and proposed utilities. ' Erosion control methnds when required. <br /> " Centerline o1 abutting right oi way. " North arro�v j' ' :7 <br /> -�---�`�_�---,� - �y- <br /> Signature ot Ap icant , <br /> PU3UC WORKS PERMIT <br /> CONDITIONS: I <br /> . . . i.�. . . �. . . . �. . . . . . . . . . . . . . . . _ , . . . . _ . . <br /> ;� . i_. . . . . . . . . . . . . . . . . <br />. . . t . . . . , . . . . . . . . . . . . <br />; , . 7-f//s :/P�.�'�i.7.` _��'. . -s�,�,�r'r: _ 7z� . ff' .�.. w. : _ : _ : : I <br />�, � � 1_t f 1 E-s�'� �'�y��,,r f,�s �Fr�-,���i-✓r� �`- : . . . : : . I <br /> � �� � � � <br />,� � '-; J�,-.��� , <br /> �,%T�' ��'�E�'��Y� <br /> � - -r j-.�_1-'. � . , . � : . . . � . . . . . , <br /> . � . . <br /> � <br /> _ i-r'--•-.- � <br /> I '--. � . - --.-_ . . . . . . _ . . . _ . . . . . . . . . . . . . ._.. .. . .. �� <br />` ' • r I A� 1 _ I i � _._. � .._ . . . . � . . . . . . . . . . . � . . I' <br /> '--�."��- + t + . <br /> _ _ 'I_ � . , . � . , _ . . . . l . . . . . . ' �� <br /> � �_� . . i <br /> �r-�— , � The untlersigoed owno• hereby agrecs to hold and save harmloss � <br /> � � � . , ihe Ciry N Everell trom any antl au ciaims lor damages, cosls, , <br />( , . . eMoenses,or causes ol actlon Ihnt may arise bccauso ol in8lallatiun � <br /> , _ _ . . . . . . . . . . . . and meiMenance ot Ihe improvemenl or other riyhl-ol-wey use <br /> �-, . , , . . . . . . . heralo applied lor enA furthei agrees lo rem�vo aemr upon notice <br /> { . . . . . . . . . - � Irom the Cily anA to replace Dublic p�opor.y Jama�ed Ih+re:y. <br /> i G��� � <br /> "'' /�.-/c _�� � <br /> AP�R ON TR�1 ON aATE� ACKhON'LEDGEMEfyT OF CGNDIYIONS � ' <br /> /i "i I -� .- . . � . <br /> Z �� i;���� `2.... f .._"'`--^-"' / 7;/. . '_• J _ <br /> APP E ASCON T UCTED D�� ` SIGNPTUREOFAPPLICANT - �� DATE � � � <br />( PERMIT IS VALIa FO 1 YEAR pOST ON CALL FO R�NSPECTIL�N ; <br />� _- -.�-, JOBSITE 2y HRS. �EFORI=_8 ONSTRUCTION , <br />� EXPIiiATION-'�'�� - ' � - <br />� <br />� <br />