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"'"�" APPLICATION FOR PUBLIC WORKS PERMIT
<br /> � \ � Type or Grint cleshY wit�ink
<br /> PRESS HARD-YOU ARE MAKING COPIES
<br /> PERMIT NO. � ��
<br /> PUBLIC WORKS
<br /> EVERETT,WASHINGTJN BLDG. DEPT. NO. --
<br /> q'OWNER ❑ AGENI DATE ��j �� ���= �
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<br /> APPLICANT/FIRM REPRESENTED J— �'� `�'' {_�—�v ' ' �
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<br /> ADDRESS � � 1� t� . -. v j'". � �_�� CITY l ���^��' ,- TELEPHONE SS i �_�? '�
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<br /> HEREBY APPLIES FOR PERMISSION TO �� �< <• � / i. � ��• '< < + � �� �' � � � �` '
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<br /> AT THE FOLLOWING LOCATION c�� � r � � �� y ` � �
<br /> Attach five(5)copies of prelimi�ary plans for proposed work Draw to scale and show the following as epplicable:
<br /> � • Property lines and street identity. • Topographic changes requiring cuts and filla
<br /> ' Outline and dimensions of existing and other than normal foundation.
<br /> proposed structures. " On-site drainage systems when requfred.
<br /> * Existing and proposed utilities. ' Erosion control methods when required.
<br /> ' Centerline of abutting right of way. • North arrow
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<br /> i sipneNreo,Apo��cent
<br /> PUBLIC WORKS PERMIT _
<br /> 4CONDITIONS. . - _ . _ . . . ; _ : . . : _ _ .
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<br /> ; � � . : , ; , : , � , , , i . Tho undersignetl owner �ereby aBreea lo holtl�nd uvs h�rml��e
<br /> _� � I �- , { . . � � the City of Everelt trom eny ena en cielm� lor d�m�0�h co�t�,
<br /> , .i f � _„ , , , , , . � .. . . . . . � erpen5es,Or ceusee o�ettlon�hel may etlse baC�W�OI IN��II��lon
<br /> t—�-'—r . �-- --- :-----.- . � � . . . - antl maintenence ol ihn imprrnemenl or olher dOhlrol•w�y u��
<br /> . 1 y . . • � ~� . � - • , . . . . . . , . � � herero applietl br end lurther epreee fo remove um�upon noflG�
<br /> � � � � � � - � � • � � � � � � � : / � - � Irom Ihe Clly end to replece publlc property d�m�0�4 �hmDy.
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<br /> � �"� ., : �'.- �"I,'/I L.__. J�ZI ��f` I
<br /> PPROV F A ONSTF�UCTIO � DATE � ACKNOWLEDGEMENTOFCONDITIONS --�
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<br /> � � �,i_.Ci� `.� �'.���'�.�.:'}� '��. �-1 ✓
<br /> A�F�SCO�y �T ., E DATE,, � �SIONA7URE FAPPLICANT � DATE
<br /> PERMIT IS VALID FOR 1 YEAR pOST�OM CALL FOR INSPECTION
<br /> 258•8811
<br /> EXPIRATtON ' ! � `� �'�-7 _ �OBSITE 24 HRS. BEFORE CONSTRUCTION
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