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f— <br /> everett ARPLICATIO(V FOR PUBLIC �1VORKS F�ERMIT <br /> � TY�o or Ptint clearly with ink <br /> PRESS HARD•YOU ARE MAKING COPIES pEflMiT NO. �� � ' _- <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON C� 7 �j BLDG. DEPT. NO.����� J.�� � <br /> ' �- �OWNER ❑ AGENT DATE _/ ��`� o � <br /> - <br /> APPLICANT/FIRM REPRESENTED _ _«<S. _ _ _ __� . �G._ . . . <br /> ADDRESS Q�G=S�t. E(I�Zt�T �/jL�C (.l�fl y CITY ���E��TELEPHONE3-������_- <br /> � <br /> HtREBY APPLIES FOF PERMISSION TO I_NS�L _c�S� ��I�D�CONCiPLy�__��PIL�7U __.__ <br /> AT THE FOL�OWIMG LOCATIO�d C�'T SS l/�C�RCEIUE E�J� - ���(�j^,�Eyt l�/.� SL'✓, <br /> Attach five(5)copies of preliminary plans foi proposed work.Draw to scale and show the followin s applicable: <br /> ` Property lines and street ideniity. • Topographic changes requiring cuts and fills <br /> ' Outline ancl dimensions of existing and other than normal foundation. <br /> �roposed structures. ' On-site drainage systems when req�ired. <br /> ' Existing and proposed utilities. `— ontrol me ods when required. <br /> ' ' Centerline o( abutting right of way. North arr w / <br /> � � <br /> Signa re of Applicant <br /> CONDITIONS: PUBLIL� W(�RKS ERMIT <br /> f. (7/RiO� �'/r � FRSc'r�+N-r f .^•r"ec� %J r�r � �� (�� �'�CR/P� <br /> / / n ,/ <br /> 2 / • L <br /> �70���r' C//Y�ina(�G /1x,�3� (7c GonT•*o��.:� un J'�P �T• <br /> ✓ <br /> 3 �� L/QM/f G O/ �i7P'FQ�t� V/� �i[��' �'P U. [�! ,o tCU rr��.a; !y✓C <br /> �e n�:,.�s�'���9-ru�, /y�J�' 6e i'Cp.riircPl�y 6roi�/c"r� � <br /> / / <br /> . e.�/ij ` � � ..,,� /=�'�✓� /�c,. � d•�ia' cvr� 'o� c�i <br /> � �T�r t� i u /i,c. 0.w, w� � r c.; <br /> 3,i�- ir ,�. �a c%yar�l/ �p ��� <br /> S �✓3.7 Wc�✓E/ SHrvic'e va�vp � � c7'�r�ai/ /jGG��d�', <br /> ✓ <br /> T�e undnrsignetl owner harrby agrees to hold and save hermless <br /> ihe Ciry ol Everelt �rom any cn� au ciaims lor damaBos, costs, <br /> expenses,or causes ol action Ihal may arise because ol inslallzllon <br /> f and mainlenance ol Ine imn�ovoment ar other nphPol�wey use <br /> � �oreto apP�ied br entl furiher egrees lo remove same upon notice <br /> �—� � Imm Ihe City nnd lo replace prblic �ropetly damaBed thereby. <br /> �/ <br /> L <br /> �vFD FOR CO 'TRUCTION E ACK O LED ENT F CONDI'f10NS <br /> - ��(.� ���.�� G+�-�� y �r i,� _ . ��__ _ <br /> APPROVEDASCONSTR CTED DATE S NA UR OFA LIC.4N� DATE <br /> PERMIT IS VALID FOR 1 YEAR pOST N ALL FOR INSPECTION <br /> 259-8811 <br /> � EXPIRATION JQBSITE 24HRS. BE=ORECONSTRUGTIL <br />