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�- - _ _. <br /> eVw 1APPLICATI�N FOR PIIBLiC WORKS F�ERMIT <br /> �� TYPe ar Prini cleary'wilh ink <br /> PFESS F'ARD-YOU/�RE IAAKING COPIES � r- <br /> PUBUC WORKS PERMIT NO. _�-LU� _ <br /> EVERETf,WASHINGTON BLDG. DEPT. N0.�0 0 a _ <br /> ,�OWNER ❑ AGENT DATE �_Z�3�._ __ <br /> APPLICANT./FIRM REPRESENTED .�!�-S_f�"�Dii'C-) 1.c'C . _. .. <br /> ADDRESS ��6: �,E __�_o'i�'CT' lJ;l1/L GUR�--CI7Y C-dE!?� _TELEPHONE ✓1 SS-��Iy.�' <br /> HEREBYAPPLIES FOR PERMISSIONTO _�NSTi LL o�5 ��/ir�E �O�✓«E7F ,iln'�✓�J���'� <br /> � <br /> ATTHEFOLLOWW(rLOCATION ��� -� I :'c�n'<ii�,t�e� E37�jj�S � � � �,� ' --,..�; <br /> — --- --- -���-�_ �_ ` <br /> Attach five(;i)copies of preliminary plans for proposeci work.Draw to scale and show the following as applicable: <br /> ` Property lines and street identiry. ' Topographic changes requiring cuts and fills <br /> " Outline and dimen;ions of Pxisting and other ihan normal ioundation. <br /> proposed siructures. ' On-site drainage system� when required. <br /> ' Ezisting and proposed utilities. � Erosion conlrol methods when required <br /> • Centerline o( abutting righl of way. 'Nor�h\arrow <br /> i / <br /> I %\ .i.., r�J� <br /> - �--f''_-�- �- �c- ----- <br /> ' . iTgna re ol App'icnm <br /> � PUg�IC VIiOR1C '' 6�MIT - <br /> A. �.�1.�aa C.;� s 'e a��-�[.-(_�:- �7' " �L-- <br /> CONDITIONS_ Ei'�, /�o �'���� �e � c;� _C'�"-e�L< >e�� .�� L f <br /> � ' �� �Jx�-���zt� � ,S <br /> �lc¢ �-z��zu'��F> <br /> � <br /> -�` ,-/ ' ��� ;� � , �n ' > � <br /> ��1,. /�oo, - f�p .�_r�zr �� « �1e. rnz > v�_ ��„ rrc l, eit or� <br /> the lo;� . <br /> a. . f{-ny dc�r?�uy � or u��taS�J � ;�.> ,.�:.;-�/; - ? r> ; � <br /> � <br /> �cour�r,y due fo co;�sr-rc,�cf;'or� n�� :s ; �.?� <br /> I"n�7�f I Y�G� ��! ULII �c"7�f', <br /> :.3; pebr�s �� trr� c/�e�: � int�� pup � � '.-� ':;: ��, �����I, ;�i��o>>-� �-n� � <br /> 1 , <br /> : . . . . �DI�StYUCZIDY) . .Sl � -!S � I�� �'.���rr� C'_C� �.t`) <br /> The untlersignetl owncr hereUy aprees to �old antl save harmlus, <br /> � Ihe Ciry ol Ever�t� tmm any ano au ciaims lor tlamaqes, co� s <br /> . . .�� � �� . eKOonses,or causos ol aclicn thal may arise 6ecause ol instel � <br /> . . . . . . . . . . . and mamtenenca ol IOr improvemen! or Olher righ4obwa' <br /> . . . . �ereto npplie�for and!arther ngrees lo remove seme upon � <br /> � � Irc��� ihe Ciry and to replace pu6lic propehy damagcC P� .. <br /> J- / ' 'r _ /"J <br /> i . //�'��^/ -'� <:/ , <br /> '�/ ./ > r`�' —1— ?2�? , . ' _ <br /> APPASVEUFOFjCON UCTION � D'ATE .ACKNOWLE9CEMENrOF ONDIiIONS � <br /> � �.-,7� 7 ( !�; i /". _� - � <br /> �_-���'�, ����- ��srai�� �--- � l --�y . - . c� _— _ Gtn� �Z'�� � j"L <br /> .� ..L �v �-�r�- - � � =�---- <br /> AP�QVES3-x:cG __-77�,.��. DATE SIGNATUREOFAP LI ANT _ DATE <br /> PtRMI"f IS VALID FOR 1 YEAR CALL FI�F� INSPE�TIOh <br /> POST OIV � 259�8811 <br /> EXI�IRATION— �AB''�T�' I 24HRS. BEV=QRECC�NSTRUCTION <br />