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�everen qpp��CATION FOR PUBLIC WORKS PERMIT <br /> TYPe or orint cicarlY with ink �. <br /> PRESS HARD-YOU ARE MAKING COPIES (��/��j <br /> PUBLIC WORKS PERMIT NO. .�n �ic,�rz <br /> EVERETT, WASHINGTON BLDG. DEPT. NO. <br /> ❑ OWNER ❑ AGENT DATE __l�^7_�'j <br /> APPLICANT/FIRM REPRESENTED _`�� � ��"'�L�C_/��- <br /> — - %- -_ — ---- <br /> ADDRESS � ��S U/n,e� �/�G�E �� TELEPHONE 7_�'�ti-7 <br /> HEREBY APPLIES FOR PERMISSION TO C�� ����� �/E'F=`S' _ � <br /> ATTHEFOLLOWINGLOCATION ___-�-� o�� � ��� /�t2 G.�. LL�i2n)��J� .L� <br /> Attach five(5)copies ot preliminary plans for proposed work.Draw to scale and show�.he following as applicable: <br /> ' Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other than normal (oundalion. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed utilities. ' Erosion control methods when required. <br /> ' Cenlerline of abutling right oi way. ` North arrow /�- <br /> . � „��! i <br /> \���t�G_rt li�! -.����LL.�_ <br /> , / / ��r Sign umolA Ican <br /> PUBLIC WURKS PEFiMIT ,% <br /> ��' r <br /> CONDITIONS: <br /> TKtS �42CA �1FE� BE6►� Gu7— <br /> a1c-IZ. t A�� VI Sll3C.E AC.TIVfI'Y -_._------- - <br /> OVE2 �oIZ SaME TIME. , <br /> � .- , . . . _. . . <br /> No oNE �N A�.EA � 5 ='� / <br /> � co�Nec.-rcD wir�l �JZ-6��C-�T �=� �J � <br /> wH A-r � 5l1I�l.L �U E ; � �i��//L.ti � <br /> ,� Cr�N51DER ,STAT�S . ��� � �;_. <br /> , / ,- � � l�/'�� , <br /> ; : Z � � <br /> _ . . . , <br /> ; � - <br /> � <br /> ° - -_ . _ i <br /> . . . . . . ./ The u qyysigned owne�nereby agrees lo hola and save hnrmless � <br /> Ine City ol Everelt Imr.i any nna all claims lor damages, wsts, <br /> � - � � � � e.penses,or wuses of action Ihal may arise because ol installalion <br /> � � � � � � - and maintonance ol thc im0�ovemenl or olher r:d�4obway use <br /> � � � ' , heroto applied lor antl lurther ngrees lo remove same upon notico <br /> �� ' ' ' � ' tmm the Ciry and to replace public properly tlameged Ihereby. <br /> , ��'— .�. �_ ,�/' <br /> �7 �� �'' /�"��� <br /> AP q ED FOR�C�9 RUCTION DATE _;--ACKNOWLED EMENT OF CONDI710NS <br /> t � _. <br /> � �_J/ , �„ - � <br /> AP � EDASCONSTRU TE DATE '\ ���9�/NATI.IREOFAPPLICA��TL�������DATE J� <br /> � PERMIT 15 VALID R 1 YEAR / LALL FOR INSPECTION <br /> � POST OP! 259-8811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION <br /> 4 <br /> A <br /> I <br /> I <br /> , <br />