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1 "' <br /> everett pppLICATION FOR PUBLIC WORKS PERIIAIT <br /> �. TYPc or Winl cleady with ink <br /> PRESS HARD•YOU ARE MAKING COPIES � <br /> PUBLIC WORKS <br /> PERMIT NO. � ���_._ <br /> EVERETf,WASHINGTON � BLDG. DEPT. NO._. <br /> ❑ OWNER ❑ AGENT DATE ����� J - <br /> APPLICANT/FIRM REPRESENTED __ ._ __ � �E�AT/p'� L-EP�t=N/NG � '� q/T�-L. . <br /> ADDRESS /�v c- 7 GII�/�-"`�� �i'J (, CG� . - CITY t'E��7�_ - - - <br /> ! <br /> TELEPHONE - 5'a -IZ� � <br /> HER BY APPLIES FOR PERMISSION TJ ����� � ��t ������� C�L� ���/� <br /> //��t �� �E/( I �f�-Q�" �`T�//C��1 i�2//¢1 ��t.Y-' !-/"j/(/i//✓L � _ <br /> % 1 <br /> ATTHEFOLLOWINGLOCATION ���7 vP���� ��nGf� �) , <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show tne tollowing as applicable: <br /> ` Propert)� lines and street identity. " Topographic changes requiring culs and fills <br /> ' Outline and dimensions of existing and other than nermal foundation. <br /> proposed structures. * On-site drainage systems when required. <br /> • Existing and proposed utilities. ' Erosion conirol melhods when required. <br /> ' Centerline of abutting ric�ht ot way. ` North arrow <br /> ����^ /2.s-3. --- __ - — — _ - - - --- <br /> Siqnature oi Applicanl <br /> Pf1BLIC WORKS F'ERMIT � <br /> CONDII ii�i�S: <br /> . . . _ . !�•i.� -- � ,. � __- . -- _-.- , -. ' .i--.. ,� � , .�� '�l i . C. "-, - <br /> , <br /> /.,J . <<J/- , ,_ , �" c _ , . ' i � ,."' _ ; ,1 <br /> , , . . . . `�-"!��<� � � � � <br /> � <br /> t <br /> � <br /> - lne unC��isrz,�neJ ownm hureby aaices �o holtl anJ 5ave harmless <br /> Ihe City of Everetl Vom any ano all �laims tor damapes, msis, <br /> � expen�es.or causes ul acllon that mey arise beca�se ol inslallation <br /> ' - � � and maintennncn ol the impmvement or other righbo��way use <br /> � � - hereto applied lor end furlher agrees to remove same upon notice <br /> � �� Irom !he G!y and b replace ocblic pfoperty damaged thereby. <br /> ��.f -_: —° I— �' . r <br /> /� ::� '�-..�. �.� �'��� ��-��,�^ / IU��r� � � <br /> APPR VED FOR ONSTRUCTION � DATE � A NOWIE EMEN C iT 9� , C ��^ ''�� ` <br /> : �-��,���f�>A�� � <br /> -- � �-�•�, .� ,7 �� <br /> APPROVED AS COMSTRUCTED DATE S! N URE OF APPLICANT <br /> SaERMIT IS VALID FOR 1 YEAR ppST ON CALL FOR �NSPECTION <br /> JOB�ITE 25�'8811 <br /> EXP!RATION— 24 HFtS. BEFORE CONSTRUCTIOV <br />