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_ � <br /> r <br /> r <br /> � <br /> everen pppLICATION FOR PUBLfC WORKS PERMIT <br /> � TYDa or Orinl cloerlY wit�ink <br /> PR�SS HARD•YOU ARE MAKING COPIES p�RMIT NO. �Z/`Z I — <br /> 1` PUBLIC WORKS 1 <br /> EVERETT,WASHIN3TON �r (1 _ �� BLDG. DEPT. N0. — <br /> �OWNER ❑ AGENT DATE —__ U -- <br /> APPLICANT/FIRM REPRESENTED �lS��uS_�+'11 E5 1n1.^�____ . __ _ __ _ _ <br /> ADDRESS�ir�-�II�"nGn �n ntL [,fJf�y CITY _���'�E���'� TELEPHONE 35S L <br /> HEREBY APPUES FOR PERMISSION TO ���� ��.� W�D� LLWC/lE'� �R��1ELJ�Y <br /> � '/� ✓6XAcc�JC E$�-i�5 – r� � UL�/a�Pne �(/a s.W� <br /> ATTHE FOLLOWING LOCAIIUN �r -SL-- — <br /> Attach five(5)copies of preliminary plans tor proposed work Draw to scale and show the tollowing as applicable: <br /> • Property lines and streel identity. 'Topographic changes requiring cuts and fills <br /> ' Outline and dimensions of existi�g and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> " Existing and proposed utilities. on control m hods when required. <br /> • Centerline of abutting right oi way. • North arr w <br /> Sig�ure ol Applicanl <br /> PUBLIC WORI� PERMI <br /> CONDITIONS: <br /> .�_.. �� �- - � �. �r . �OOr- "1�/� [l/'si'.nei', � n+H3{' ��c° COn�.ro/��.L pv� 1F�e �o�. . .. . <br /> i . . . . . . . /1 / / / <br /> �� � . . . : �. �. .o�. f'M da.nas<, or 6/CnKa3C. f/a �uf'.✓.c ��tif'-or� w"/ <br /> t . . . _. . . . . . . . . . . 1� n3f'r.[cric.. Mw3f bN /7�/Ri/f� <br /> �[Ga(/l'IH c/4( /�' � . . . <br /> 6r 6�,�ci <br /> . ._.._ - •3 ��•6r,s -f1iar�'c./ ' .,. 'o /�„4G� ,Q. o. c✓. -75v.•,-, /�/,.f <br /> . I . . . C�7/IS//'Nc.7iOn 3•?e /3 T� �C G'/C�'nr0.'t�P . di.4� . . . . <br /> , _ . .. �.. . . . . � <br /> .. . . ..-: __:-. �-. . . . . . . . <br /> �. . . . . . . . � . . . . . � . . <br /> . . . . 1 . . . . . . � . . . <br /> ' ' ^ --`—�� �-���� The unCr�signed owner Oereby agwes�o hold ane save hermless <br /> ' ' 1 ' ' ' + ' ' ' ' ' � � � � � ; , No Ciry ol Everou Irom any ano eu ciaims lor Enmagea. cosls, <br /> . . . . . . . . . , - � � <br /> , eyponses,or cnuses ol ection I�et mey atlse boceuse ol Inele a ion <br /> � . . . anJ meintei.nce ol Iho Improvemant or olher riphbol�way use <br /> � hr.eto aOPIIOA Iv nnd lurt�er agraes to remove somo upon nolice <br /> � Imm Ihe City end to rep�ec^ puhlic propotly Aamaged t�ereby. <br /> L PP�ISVED RCON�ION ' DATS�� CKNO IL GeM OFCONUITIONS � <br /> ' '7 � �- <br /> �r � �,i,`2�.� / s'i �' <br /> APPgOVEO AS CON T UCTED DATE SI RE O A P ICANT DATE <br /> �'ERMIT IS V LID FOR 1 YEAR CAI_L FOR INSPECTION <br /> POST ON 2�g-gg11 �y <br /> EXPIRATION— JOBSITE 24HRS. BEFORECONSTRUCTIOPI <br /> L <br /> �J <br />