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r <br /> ; - ' <br /> �everett qppUCATION FOR PUBL{C WORKS F�ERMIT ' <br /> TYPe or print<learly wdh ink p <br /> PRESS HAqD-YOU ARE MAKING COPIES pERM1T NO. oO��-�� � <br /> PUBLIC WORKS <br /> EVERETf,WNSHINGTON <br /> ❑ OWNER �AGENT DATE �`/��F� L BLDG. DEPT. NO.�� /3a3 <br /> APPLICANTJFIRM REPRESENTED �c��-(C �-�rS T �JZiyn.� _ S.w„�� � Lcty� _ <br /> ADDRESS �•�� �X ._�____ _ __ _ _ .. ____ CITY �i,�.Nw�cx�._.TELEPHONE7Z��ZSZS <br /> HEREBY APPLIES FOR PERtiiISSION TO Yv_ ! NS7x.�t__aV_1_u��v_�j__�:�.1_���-..� 6+� <br /> � <br /> - --- S'-�'`-�� - ---— - ---- <br /> A'f THE FOLLOWING LOCATION __ I�O I Z � S �' 17(� � C_. _ r yt��, <br /> Attach (ive(5)copies of preliminary plans for proposed work. Draw to scale and show the foliowing as applicable: <br /> ' Propertp lines and streel ideniity. " Topographic changes requiring culs an� �its� <br /> ' Outline and dimensions of existing end ottier than normal foundation. <br /> proposed struclures. ' On•site drainage systems when requj�@d.� <br /> • Existing and proposed utilities. ' Erosion control methods when requiret�.' � <br /> ' Centerline of abutting right of way. ' North arrpw ^ • a�• ;,� <br /> \� �. �4 <br /> �"`�-�� ��� �t ;ti��. <br /> � <br /> Siqnalure ol Applicant \'•� v� <br /> � � <br /> coNomorvs: PUBLIC WORKS PERMIT "�:.; ° .. o�s,o`�� <br /> \,�-� �,� <br /> �� <br /> � 'J Q <br /> I• f��l Valfl `.��,��.1� �:JC �. i C�:.. � �ui ��-. n.:. f .. .�\� !'...r . � ..l�- <br /> 1.+.'�� ..� C .�r.ciE{ �[j ,.�i �. n..0 �o.,o{r�tc4�w-. --\o...,�.� ��. ... .1 . <br /> J�l'C�'�l �-� \J.�\ <br /> c: M��'-` <br /> �. .�.�e,� ;.�����uu...�� ��.nll be �:c'�� �'In.i •. a�.���,ro., •� L�.� <br /> �� <br /> ,,,.�ol�� Jt �`v.< .- V �2, 1d�F L_ <br /> The untlersi9netl owner �ereby agrees to ho10 and savo harmless <br /> t�e Ci�y ol Evere�l trom eny antl all claims lor dameBen, cosie, <br /> e�penses,or causes ol aclion Ihat may arise beceuse ol instellation <br /> and mainlenance ol ihe im0�o�emenl or other riphFol-way uee <br /> �erelo epplietl lor antl lur�he!agrees IO remove same upon notlCe \ <br /> ( ' Imm the Ciry anE lo replaca public pmperty Aemeged Ihereby. �`�� <br /> �i—_ <br /> / i/ / j .Jt � � ��• <br /> C �— � <br /> -- (� ROVED FOR CO TRU ON � � ACKNOWLEDGEMENT OF Gb��IONS <br /> y�!�"i ,. / � <br /> - l,I�QQ `�Izy �3 — �;1��� ",� � � ; <br /> APPFOVED AS CO TRUCT DATE 51(i�41URE OF,.APPLIC�A� ' DATE y '� <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL Fb{i INSPECTION <br /> EXPIRATION � � `� � _ JOBSITE 24 HRS. BEFORECONSTRUCTION <br /> I � <br />