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_ 'l <br /> r <br /> 1 <br /> r � <br /> e°� A°PLICATION FOR PUBLIC WORKS PERMIT <br /> 0 TYPe or Pnni UeatlY w�i�mk _ j_ ._ —'"__ <br /> PRESS HARD-YOU ARE MAKING COPIES pERM1T NO. ��j :� � � <br /> �' PUBLIC WORKS BLDG. DEPT. NO.������°z y '� <br /> EVERETf,WASHINGTON '0—/3_�' <br /> �GWNER ❑ AGENT DATE ��� . <br /> APPLICANT/FIRM REPRESENTED j�T<«S - ����5 'f'�'r� - - - - --� - <br /> �y � ✓���Ti�_ 3ss�yYS�- <br /> ADCP•FS50�=4'—Sit-�EU�E'�/I�/�L..���----CITY E_-- -TELEPHONE — — <br /> HEREBY APPLIES FOR PERMISSION TO IuS/��- -0��,-Y"���-��`�N��'p����v�,���" <br /> - - �- �- --- -- - _ . _ . <br /> ._ _..- -- --- ---- <br /> — � ---- --�- — .- _. _ . _ �f y'/� <br /> ATTHE FOLLOWING LOCATION CCj�-L?L.__�C'��-F-�-�-��-c='�����J-='�- UC�����e �•t� S. �U. <br /> Attach tive(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> ' Property lines and street idenli!y. ' Topographic changes requiring cuts and fills <br /> • Oulline and dimensions of exisling and olher than normal (oundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ` Existing and proposed utilities. ' Erosion control eth�ds w�.en required. <br /> ' Cenlerline of abutting right of way. ar�ovi <br /> �\1���` Si iaW�olAu0licant--__ <br /> coNoirioNs: PUBLIC WOR S PERM T <br /> 1� �(eer - L�. •It � �aSr.++e.�� arc« �5 n�i � be. elenr�� <br /> ;7 1 � Go.�'Ero II�.Y �.. 'kl.e �a �'. <br /> Z. fiGoF'T�() c�fn�..n�L �++HS,' b . <br /> .�. Qn� d�m.�Sl cr bre.��-n�c 'w P.V�i� R�w urc..�r�n� c�He N <br /> .� „ � <br /> c....•a1r..a1-w., mN�F be �e(�n.'r,t b b. 1 tr. I <br /> � �f.�]CI) r. [1c1�M1O �wl� ��t4i �i� �/W �j�p�.. '�„��1 U�ls�frc�iu.� .if'C 11 <br /> {., ba cleu.� w� »� c�cr, �� . <br /> �J. 1'b,N7r W^��•^�f ''-�L'fJ�cG Vn�V4' boti �. �ns✓I �4t" e�f•ie�C'. . <br /> The uraersi9ned o.v��cr �c�cUy 9U�ees to nol0 a�d save�eimless <br /> Ine Ciiy ol Eveieu trom any ana au <iaims lor Camayas, cosis, <br /> oepen5es,or causes ol action I�et nay adse becauso ol inalallallon <br /> sna mainto�ante ol t�e impiov�ment or olher riphl�obwey use <br /> �eteto aOPbed lor antl lurther aBrees to remove aemo upon nolice <br /> ,/ Irom the City and to �eplace Oublic oropeitY 4emaqeC �hereby. <br /> L � i�(�Y/^__ �_� /�' � ` d <br /> � qQVED; CONSTRUCTION ATE• AG N WLEDG MENT OF CONDITIONS <br /> � p ( 0 ' � tF 7-- <br /> � Y (�, ��. /((�L�� �]��' �� -�� ---�� <br /> pNATUR� F PLI ANT DA��E <br /> APPROVED AS CONST CTED DATE . <br /> PERMIT IS VA FOR YEAR % CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> � JOBSITE I 24 HRS. BEFORECONSTRUCTION <br /> EXPIRATIGN <br /> � J <br />