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r- <br /> `VefO" APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Prin�GeatlY with ink <br /> PRESS HARD-YOU ARE MAKING COPIES p�RMiT NO. ���3�� ` <br /> PUBLIC WORKS ' � � <br /> , r_. EVERETT,WASHINuTON BLDG. DEPT. NO._��J�� 3 d <br /> �OWNER ❑ AGENT DATE ��_^�3�� --- <br /> APPLICANT/FIRM REPRESENTED f'I(lC(S. �J�tC'T__�il.1Ci _ . ._ _ __.... _____ <br /> ADDRESSIS�.��+—L��S�u�1T lJ/)il�C�f�.y CITY EV��� TELEPHONE ����yy�y _. <br /> HEREBY APPLIES FOR PERMISSION TO /LUS%H«-��L����d�Y����� ���t`��y — <br /> - - - ---c- - ���-sY-'s - �/8 �������� lU.: .S. 1.., <br /> AT THE FOLLOWING LOCATION C!�'T�nb'V iR/)tEN� • <br /> Atlach(ive(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 /> " Outiine and dimensions o( existing and other than normal (oundation. <br /> proposed structures. " On-site drainage systems w7:en roquired. <br /> ' Existing and proposed utilities. ' Erosion control methods whe�i required. <br /> ' Centerline of abulting righl of way. ' No rr w <br /> -- y�L - � <br /> i nalure ol ApPlicanl <br /> coN�irioNs: PUB�LIC WORK PERM T <br /> 1. l9/cr., - I��ol!" raSP.,�nP.� f arrn is no� �o �e c/�ctrrc/ <br /> .�... �GOt - -�� C�rrt�nnSG inu5f- �it (.Y�n'�/4��n�,n.+ ��ie ��� <br /> V <br /> -3. {ixy (IpN'�?�L o� tlCP�.tl�uSt '�a {ab�i� R/�v oCevr�.� ` e�v�� � <br /> � CJ <br /> oo.,��r,.�b,o.. �.,uo : b<- «pn,«•� b.� b�:J�lrr-. <br /> � �hris -}rnr.�cr�Q �H� �;.b�'�)� ��w ..�.-. ��+�; w�.����.c�-io-. <br /> s��{. �S '�^ loe C?;qti �Y �...P an,��l. <br /> S. �{J��y�' W,�ev SefVicG. vn��t b�u' '� -1'�.:n.' �oY � (Y��G.. <br /> � ihe undersi9ne0 owner heicby agrces to hold and save harmleas <br /> Ihe City ol Everetl trom any ana au ciaims lor dame8e5, cosis, <br /> eapensos,or wu:es ol aclion Ihol may ariso 6etause ol inslellalion <br /> and naintonance ol tlte Improvemon� or other righ �Ol�way use <br /> harelo applietl lor and lurlher agrees to remove same upon noticu <br /> � Irom I�e City and lo replace pu61iG prOPerty Aamapo0 Ihereby. <br /> �� ' <br /> y�- . �:u�_ �- � <br /> AP H E � �,�CONSTRUCTION ATE ACKNO L DGEME T OF CONDITIONS � <br /> ��. � ll(f�� G, L �C�y ![C+1� �� (�r7r - ��/ R �%P]' <br /> APPROVEDAS�'i:UNSTR ED DATE SIG Ti1RE0 AP ICA — DATE <br /> PERIIAiT IS VALI OR 1 YEAR I p�ST QN CALL FOR INSPECTIOld <br /> 259-8811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION <br /> I - <br />