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� - <br /> r — � <br /> e"P`e" APPLICATION FOR PUBLIC W()RKS PERMIT <br /> � TYGc or Print clearly wilh ink / <br /> PRE55 HARD-YOU ARE MAKING COPIES pERM1T NO. ��`�`�'�_ <br /> PUBLIC �NORKS / <br /> EVERETT,WASHINGTON � ��/ �/ <br /> � <br /> BLDG. DEPT. NO. o /a9aJ <br /> ' - ,I�OWNER ❑ AGENT DATE . �.__-��?--� �) <br /> APPLICANT/FIRM REPRESENTED ..�« �-S__�IIL�-� _ �-�-{.LL_ __ _..__ . <br /> n�oRess _a�G—.S�LE�c-�'E?l�t'_ �U c:�%C:�t.r!_ <br /> ��CITY TELEPHONE ���SS' ( �^%� <br /> HEREBY APPLIES FOR PERMISSION TO LN� � �� �S �/�(!)E ( //UC/C�L- i� ��k/(iE7V/i-` <br /> —/-----/ / `�-7 Z�i-lJ�Y C° /' , <br /> ATTHE FOLIOWING LOCAT�ON Cf,1—G'`�—��"r<_��</��� �_.c� << �' /�R/L'v1e Wa S,LcJ� <br /> Attach five(5)copies of preliminary plans tor proposed work.Draw to scale and show ihe following as applicable: <br /> ' Properly lines and sireet identity. ' Topographic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other than �ormal foundation. <br /> proposed structures. t On-site drainage systems when required. <br /> ' Existing and proposed utilities. '.Erosion con!rol m hods when required. <br /> ' Centerline of abutting right of way. ' North rro <br /> J�;`/� �`� <br /> S gna ure ol ApP���anl <br /> coN�iTiorvs: PUBLIC WORKS PERMIT <br /> � <br /> I. '� Czrer.+ �i�4-I (,'GeSPvriPw�- ar�u. i� �a� �-� bC clearP <br /> 7_. �oo�_-�..� elrc..,..u�jr.. v�n�t�F- �t e.oV.-�-�11n� u,,. �e la-r; <br /> 3. ��+y L1Aw.n�-C a�r breaFaS� -� �i.tib���t. R.l�. W. G`CCvrin` G�HN <br /> J <br /> � co„5•1-�,,.G-�4,.� vhHs�l- b� re pa..rnQ b.� b.,, �de� <br /> 1' c/c�r13 �e�raV 1.,� ��tb�'H. Ic. C�. I�J� �-'�"✓Ovy. ^LM�S L•o✓SP/� <br /> �.�G /S .� a.2^C'. C�Panrc� u� dQi�y, <br /> (� 1 � <br /> SPFdJK7�' WA�Ct SP-('VIt� L7Gt�VC. �pi� � , /�C����'. <br /> T�c unctcrsignetl owner �ereby egrees to hold antl seve harmless <br /> tne City oi Ever:�t trom any ano au cialms lor damepes, cosls, <br /> expensrs.or causes ot action Ihel may arise because ol inn�allatlon <br /> Bnef mainlenance ol Ihe impmvemenl or oth� � riyn4ohwey use <br /> horeto appiieJ lor and lurther egrees b rem . ane upan nolice <br /> ° Irom ihe fity and to replace public <br /> / propf ��nnged �hOreby. <br /> ��fj� S�s �2_ <br /> ��OVED FOR i3ONSTRUCTION AT ACKNO .DGEM T OF CONDITIVNS - <br /> � <br /> _ �, �i �=' •'� �� i � 3��yZ.— <br /> APPROVED AS CONS UCTED DA7E SIG A URE OF P�ICANT DATE <br /> PERMIT IS VALID FOR 1 YER�R pOST ON CALL FOR INSPECTIOfl! <br /> JI�BSITf: 259•8811 <br /> I EXRIRATIOH 24 HRS. BEFORE CONSTRUGTION � <br />