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_ � <br /> r � <br /> r - _ <br /> - - ----- ---� '� <br /> everett pppLICATION FOR PUBLIC WORKS PERMIT <br /> 0 TYPe or Grint cleaelY wilh Ink C <br /> PRESS HARD-YOU ARE MAKING C'JPIES pERM1T NO. �� y � <br /> PUBLIC WORKS gLDG. DEPT. NO. �3 . ���' n9 <br /> I� E EaETT,WASHINGTON L -� � <br /> n c' <br /> `- v S— <br /> �OWNER ❑ AGENT DAT�S _.S- � - / �, <br /> /Yir��—�CJ^_L..—�Lt-f_------- <br /> APPLICANT/FIRMREPRESENTEJ — ��� 3 ,�c ��qq�r �7y7 $a <br /> <�'I�U "'�L��..�fi,��c�/—£,•V- :���—� CITY ✓2�. TELEPHONE�� <br /> ADDRESS .J1�� i <br /> ��� CI �f i z.l �✓!✓et'C.v <br /> HEREBY APPLIES FOR PERMISSION TO --�-�5- �--�-7/— <br /> U <br /> � — / �/�.�C` � ii� �v�>. .�. �e <br /> �1 ,r-i <br /> AT THE FOLLOWING LOCATION i�jn����'�1�—� <br /> Attach five(5)copies ol preliminary plans for proposed work Draw to scale and show the following as applicable: <br /> � Property lines and street identity. 'Topographi;.ch2nges requiring culs and (ills <br /> other than normal foundalion. <br /> ' Outline and dimensions of existing and . On-site drainage systems when required. <br /> proposed structures. � Erosion control mathods when required. <br /> � Existing and proposed utilities. • Nort� arrow <br /> • Centerline of abutting right ot �+ay. � <br /> � _�y� ucen� <br /> �--giynaNre ol A 0� <br /> pllBLir WORKS PERMIT <br /> CONDITIONS; <br /> i . . . (� ( p, <br /> , . . . . . . . .�• L �.v. . L\VYt'rn.�l". cl..,.� �J[��lL�(0..�1�..� �[.t' 4...nPf 51t. 1 �i1�C. . . <br /> ( � Y � ��' <br /> . . . . . . . � . . . �.KPh��_rS� l:.,. a�/ rG �uf.+� v <br /> ' ' ' hust �oC <br /> 3 w�,�ks �,�;�..., �\�.�1-z �<< .r;k- <br /> . . . . . . . . ��e�4_? . .�� ,.•> � <br /> �. . __. ._.._ . . , F <br /> : . . , : . ; i5. �S���P.� �e�Q,�� 7/3 3 <br /> � ; . i : : 4 : , : __ : : : : . . . : . . . : . . . : . . _ : : _ : ._: . . . : . <br /> --� I � ` �� : : : r � : <br /> , . . . . ; , <br /> � � � � �.�_ _. . . <br /> �._: � �;� _ . ` . . - i <br /> . - � . , . . . . . . . . . <br /> , -, . <br /> , " . . . . : I �: . . , . . , � . . , � <br /> � . . . . . . . . . <br /> � � �'��—`i�— ' ' ' ' � - � The untlersigned owner herebY�Brees to hold:mtl eave�armless i <br /> � . . ;� . .. 4 � . ��- , • � Ihe Cq o� E�eren tmm eny nna nu Ualms lur tnmepes, cos's � <br /> ' � ' esCenses,or causes ol ectlo��het may erisn bacnu'�ol insla�la�iun <br /> . . . . � . . . . . . . . . . � anC maintone�ca ol I�e imDmvem5nl ar othe .�o6weY we <br /> . . . . . . . . � � - � � - � - � � � heroto aOP��etl Wr and lurt�e�egrees to removr � . up0�nofco <br /> � � � ' - ' � - Imm the Cily e�d to replace putlic proOaM` •'� ed I�ereby. <br /> "���X//l/�f/�' � ' /i- J <br /> A- ---�� ACKN WLEDGEM NT OF CONDITIONS . <br /> L, p VED F9 C STF7UCTION \ � �� �J,,... <br /> � -�' � ��� `���—� , ,y - - � s� -. <br /> qp p CONSTR TED C1A E <br /> Si(iNATUREOFA L�CANT AT <br /> CALL FOR INSPECTION <br /> PERMIT IS VAL�d FQR 1 YEAR ppST ON 259•8811 <br /> JOBSITE 34 HFtS.BEFORE CONSTRUCTION V <br /> L _XPIRATION <br /> �- J <br />