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r <br /> feverett APPLICATION FOR PUBLIC WORKS PERMIT <br /> I� TYPe or orint cleatly with ink / <br /> PRESS HARD-YOU AHE MAKING COPIES pERMIT NO. ������ <br /> PUBLIC WORKS — <br /> EVERETf,WASHING70N ) -�,/ / <br /> �OWNER O Ar=ENT DATE `[ ��'/'��"'__ BLDG. DEPT. NO.F�•�l I6.�� 'I <br /> APPLICANT/FIRM REPRESENTEr �(LL[S �7Z� _�j(,^� _ _ _ <br /> ADDRESS��S�C. L���L�_�YIfl.C. (�(f� CITY 4���� TELEPHONE��S�� <br /> HEREBY AP'rLIES FOR PERMISSION TU ��t�' PS/ �v/� �fL(.�ti°�*T.�+ �(UC-Lt/sj�__ <br /> ATTHE FOLLOWING LOCATION �%,�p_��AtE1.tT`Q�R'jL_-�- �j����a//e �(/R„ ,S C�J <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> • Property lines and street identity. ` Topographic changes requiring cuts and fills <br /> ' Outline and dimensions o( existing and other ihan norr+ial foundation. <br /> proposed structures. ' On-site drainage ;ystems when required. <br /> • Existing and proposed utilities. sion��jontrolf�ethods when required. <br /> ' Centerline o1 abulting right oi way. � NoD��o' f ``— <br /> / <br /> � igna W re ol Applicant <br /> CONDITIONS: PUBLIC WO S PERMIT <br /> � � '� <br /> C9~i'ern - �/� ' eASP.n �.•,f v�ec� /s .�07� d e <br /> � l�a,��P — <br /> Z. �(7c U 1-- �u/� c.��Ai N t!S E? /N k S/- �e C,O rr �rv ��r�l� 0.,, <br /> � /�� <br /> 3' �" ci�w�»QS e o,/- b�/�r/c�rs e � �6/� �'U. Gu / <br /> �UCtu�n.�J� QI�P �T�7 G�J11 ��'u�-� /?'IG�S�� b�. <br /> /'�/J �'i rN� �� .ba. ��r-. <br /> ��ebr:s-fn -:L���i%� /�,�/d iP.o. cu.�ica„ v`�J cc�nsJru��ti s,✓� <br /> ij ti-• 6� c%sr., c�L � .%r./ <br /> 'h �k3+ wF�e�_S�Y✓�[ G' Tne unders�gned owner here6y agrees to ho tl and save harmless <br /> � J /� '/ Ihe City ol Everelt trom any eno an ciaims lor dameBes, cosis. <br /> U.1'�✓L W� �j ��G�J expenses,or causos ol aclion Iha�mey a�isP because ollnstellalion <br /> / enC mainicnance ol I�e Improvomenl or ot�er iiqh4ol�wey u5e <br /> /Q�; r�r2� here�o applied for ana lurt�er agrees to rnmove seme upon notice <br /> ./� irom Te Cily and to replace Ou61ic praperty damaBeA �hareby. <br /> �7 � �L i <br /> ED FOR ONSTR TION D � CKN W EDGE ENT OF CONDITION.- <br /> �� � � 1 ,., �yc__. ,,"�`' �. ��< `� !�`"� . 1 � <br /> ,�. <br /> APPROVED AS CONSTRUCTED \ DATE �1 ATUR OF PPLICANT DATE <br /> � , <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION <br />