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� <br /> e"e`e" APPLtCATION FOR FU�LIC WOFiKS PERMIT <br /> � TYPo or Print cleadY with ink � <br /> °RESS HARD-YOU ARE MAKING COPIES �K � � Z <br /> PERMITNO. _ _l --. <br /> PUDLIC WORKS <br /> ' EVERETT,WASHINGTON B�DG. DEFT. NO..- <br /> ❑ OWNER ❑ AGENT DATE � __".-�2-" <br /> APPUCANT/FIRMREPRESENTED ��L�S_ � ,`����`���-=' -�-�VL� - - — -_ <br /> � ADDRESS �IC; S� F t' �!� �, �T1_FYII�= �- W�` GTY CI�E)ZE !I TELEPHONE 3�� y I� <br /> HEREBY APPUES FOR PERMISSION TO .�'USi����C o�5 � /Lw<,P£'7� L�r�'�_"_-_�<�r�'/ _ <br /> -- --- - - ------- ----- <br /> , Cor 57 <br /> AT THE FOLLOWING LOCATION _ _�yU 7 �(�/q I�,� g li�/o S LV (/�/-7�' �-:�'c' i `�%/1:C ", <br /> � ------ - -__ - --. .___y-- -- ------- <br /> Altach five(5)copies of preliminary plans tor proposed work.Draw to scale and show the following as applicable: <br /> • Property lines and street identity. ' Topogranhic changes requiring cuts and (ills <br /> ` Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed utilities. iEresion controLmethods when required. <br /> ' Centerline of abutting rioht of way. �' ' Nor�h arrow / / <br /> � , � /� <br /> _ '�'i'/� �����`-�- -- — - <br /> : ignatwe of AGPI¢nn� <br /> PUBLIC WORKS FERMIT <br /> CONDITIONS: <br /> , . . . . Roo� - �.�� c�ra��..a�.� .,.+ aF be Lu.. �rt>(�iJ�� oH i-n<� jo {- <br /> . . ���I�Y�L CG.a' C-t� /�LG['L.�/d-- �'7'� �"LG'Lt.�LLl�� Clc!/ !G✓LG'cGC� <br /> . . . . - �� i it� C �I ��'!� �': ��� <br /> ` ,� �- [`; � , li! <br /> l� <br /> FEB 8 1982 <br /> , . <br /> _..__ <br /> I � CITY OF EVERETT <br /> � . Public Works Dcpt. <br /> r_ _ ._. . . _ <br /> ' � - � The un0ersiyned ownei hereby agrees lo �old and savc harmtess <br /> ' � - Ihe City ol Everelt trom uny ano an cieims Inr damages, costs, <br /> eKpenses,or causes ol action Ihal may ariso because ol installetion <br /> . and maiNenenco UI tl�e improvement x other riqht-obway uso <br /> , . hvreto aOP��ed lo� and furlher ogreos il remUue same upon nolite <br /> . / Imm the Giry and to replace public .iwperty dameged t�ereby. <br /> � �- i 5I-[f L <br /> ii %�;;�'' �- <br /> -�f P� R CONSTRUCTION DATE � ACKNOWLEDGEM�NTpF CONDITIONS �- <br /> t: /''t t-�i�__ .� ?��-_ . �`�-_ � % / / <br /> l , i� -�/ / ��i�� . , r�_ <br /> - -� � - - <br /> APP AS�O�STRUCTED � 'DATE S16NATUR[OF APFLIC;ANT � DATE <br /> PERMIT IS VALID FOR 'i YEAR pp$T UN CALL FOR INSPECTION <br /> 259-8811 <br /> 2 - `1 - �3 JOBSII'E 2�4 HRS. BEFORE CONSTRUCTION <br /> EXPIRATION-- <br />