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everett qppLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Print cleady wilh mk <br /> PRESS HARD-YOU ARE MAKING COPIES pERM1T NO. �' 3� <br /> PUBLIC WORKS .. <br /> EVERETT,WASHINGTON —7 �� BLDG. DEPT. NO. <br /> �OWNER CJ AGENT DATE .�v� __C. �_��� <br /> - ,' ` ,\ �F��� _. . . .- ----— <br /> APPLICANTiFIRM REPRESENTED . .��vl�---�t'�- -' - — <br /> ADDRESS ����'L3 t ���--f "`� ���'-'" CIN �'"� TELEPHONE •?��—���I <br /> HEREBY APPUES FOR PERMISSION TO . �N`��'�L-�- A����=�-�1'� l ��1-'�_. <br /> T>r�Z�1=_ �c_+� ����E 1��L�it�, <br /> ��-� — — --- -- �c <br /> ATTHE FOLLOV'��NG LOCATION _�. � ���`'T������'1--�----�i �(��tS� "��Z� � �=-+ , <br /> Attach tive(5)copies of preliminary plans for proposed work.Draw to scale and show the tollowing as applicable: <br /> ` Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> • Outline and dimensions ot existing and = On•shte dha nage syste ns when required. <br /> proposed structures. <br /> • Existing and proposed utilities. ` Erpsion control methods wlien required. <br /> ' Centertine of abutting right cf way. '�fJort �rrovy ' I <br /> I <br /> t�- ! J��' ---- <br /> /���� - —signhWrealAoolicam -- <br /> � PUBLIC WORKS PER�IAIT � <br /> CONDITIONS: , ,;� � rY' ` <br /> r- _ _ � JI <br /> 11I � : ._'�r'�/C�,�: <br /> ; � <br /> � , <br /> � �� \ " _ � , _ . <br /> ��� , <br /> � — � _ �.� } _ _�s,�u�- n;,��� <br /> - <br /> - __-- �� <br /> ,,--- . _ :�s �z = <br /> __ ��.�;������� -��;t <br /> .=� � � �r����` --t�,..���.�,�-� <br /> ��� <br /> The undeisiyned owner nereby a9iers Io bold an0 5ave harmless <br /> ihe City u' Everetl i�om any ano au ciaims br damage& eon15. <br /> eMpenses,or causes ol ltlion Ihal may e��se boc5u98 01 Inetellelion <br /> and mamlonance ol ��e imp�ovemenl or olher riph4oi-way uea <br /> hewto aPplieA for and further ag�eos to remove seme upon notice <br /> / �' � Imm ihe City and lo re0�ace Oublic pm0erty dameped tharBby. <br /> �._ j ' f . V / � <br /> ��- �f � � _-� " � �i <br /> ` ' � " �1� �� Z - <br /> �' APP OVED FOR CONSTRUCTION DATE .� � � AC NOW�D EN f CONDITIONS <br /> � � // (: <br /> ' i � > . <br /> . �(.�r��. —Y—'.._�� � ��. <br /> ?PPROVED AS CONSTRUCTED � � DATE S �IURE AP LIEANT DATE <br /> PERMIT IS VALlD FOR 1 YEAR CAL.L FOR INSPECTION <br /> POST ON 259-5811 <br /> ,IOBSiTE 24HRS. BFFORECONSTRUCTIOi� <br /> EXPIRATION <br />