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1 _'__" <br /> everett APPLICATION FOR Pl.IF3LiC WORKS PERMIT <br /> � TYPe or Orni tlearly wilh ink _— / _ <br /> PRESS HARD-YOU ARE MAKING COPIES <br /> PERMIT NO. -� 1 � Z � — <br /> PUBLIC WORKS - <br /> EVERETT,WASHINGTON � r/� BLDG. DEPT. NO.F b �� <br /> I�OWNER ❑ P.GENT DATE L� E <br /> -1— --- - — <br /> APPUCANT/FIRM REPRESENTED .,�_i -L�S--I�YvJ-�� _�iflL __ -- <br /> ADDRESS 4� E, �y�iP� /,��� Gv/T7 CITY �v��TELEPHONE�s�%� <br /> HEREBY APPLIES FOR PERMISSION TO J�� �S�� C�BNP�P�I� �����ti>f`� <br /> ATTHE FOLLOWING LOCATION ����_D�/C��' �����!-n��-�y "�� r ��--�LS,W <br /> ✓ <br /> Attach five(5)copies of preliminar,�plans tor prcposed work.Draw to scale and show the following as applicable: <br /> ' Properiy lines and street identity. ` Topographic changes requiring cuts and fills <br /> • Outline and dimensions of existin� and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed utilities. ' Erosion control methods when required. <br /> ' Centerline of abutting right o( way. ' A!o h arrow <br /> ��1_/ �_(� ---- <br /> 5i�naturc ol ApPlicant <br /> PUBLIG WQR . PERMIT <br /> CONDITIONS: 1 I <br /> . . �. �Oc_� l -�{o '� <� r.� ,..�:�. ..�..�-,h �Jc' cc�.,. -(-��� �I� �\ c :. �� i� e� Ic. �t -- <br /> \ I � t �� -] y i' <br /> . . . . . . . . �:. 1lW� cl'C�Itct ,.•:_ � YJ(�.'.�I� � ��\'U �.�b��a: � �,�vi-� cl- _ ��..�..iy <br /> t w:�' � <br /> . . . . ��r.i...rl'.. i,u 'tti .Ca:NS�TNf�lv.•� •.v.�qs�'- bt �l�p[l�f r`.S'. �.1 <br /> . . . . . � . . . . . � . . . . . , . <br /> . _�-. i.. . _ _ . . . . . . . . <br /> . . . . � . . . . �.11�(1Lr . . <br /> ' `� '_qc_S:�� "-tYn c��r.�L.'� �n.,v 1�.,b�«c l�� ����5- -u � -w a7 .{;ti ,� <br /> . . . . _ . '-,!�\ '/ C+'114 :lIrtiCl.�ri.t ".5�.' t� j i `U l'�c_ l Ife.:�\r 1 ,� ..,�v .:,IP���� <br /> �, .'J i'l� Cc'�.-:L L. i_/�iVDSC�/�-/�Ep f /A,�C L���1��j /�F��-1� GN�`iL' ��t-i_5 <br /> tU �l/L�� LE(�D.S�� Li9 r�. O%�C�7Z}l 'TL� �l 1)�GU/�-t.K <br /> a � tf!���� iH��`� !�f�= G��� �'F �.�C�T CL'i L���S.'�, <br /> j, /�ES; �"c.CL.�/'i'/C C <br /> � � � � - � lhe wiJe,siyocA owner heieby aJicos to hold and Save harmless <br /> Ihe Cii)' o� Fvt+rell irom eny ana all claims �or damaBes, cosls, <br /> � � evpens^s,o'causes ol ac�ion Ihni may arise because ol lnsinllatlon <br /> . . . and mninlenance ol Ihe improvement or olhe: righFo4way use <br /> . . horcto ap���etl lor and lurther npreos tr�remova same upo� nolice <br /> irOm Ihe GIy and f0 repleCe publit pro0erl)' dema8e0 thcreby. <br /> _ -�-7 " / <br /> ' ; '�' IlSf ��,-3 t : <br /> %AGT�ROVED F R/ ONSTRUCTION DATE � ACKN . DGE T F CONDITIONS, <br /> > > � c ��/� o <br /> � _� - � <br /> ' ( . j _--- ' 'i , � �— � c��,f � L --- + ` '. ��_ <br /> �„ - � r_ (.0 .t ��- '—� -- <br /> APPROVED &CON�T�CTED DATE SIGNATI�.REOFAP ICANT DATE __ <br /> PERMIT IS VALIb fOR 1 YEAR CALL FOR INSPECTION <br /> �� '�OST C7N ;159-8811 <br /> EXPIRATION y '� ' '� ' _ JQBSITE g4HRS. BEFORECQWS'TRUCTION <br />