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=��` APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYGe or Print clearlY wll�Ink <br /> PRESS HARD-YOU ARE MAKING COPIES pERMIT NO. �� ' 2 �" <br /> PUBLIC WORKS �/�y'� <br /> EVERETf,WASHINGTON ,/�Z/��-y BLDG.DEPT. NO. <br /> �OWNER O AGENT DATE ��� <br /> APPLICANT/FIRM REPRESENTED <br /> �iLuS � � � -- <br /> ADDRESS g� S,� EL��Lc_17`/nAt� GU�S� c�rv �E�c/T TELEPHONE,L�'y� <br /> HEREBY APPLIES FOR PERMISSION TO �S L �'�/ ����� CD��6� �t�G�IR�— <br /> � <br /> ATTHE FOLLOWING LOCATION �� 'o vE'���G �' �•77� – �e�.� UC',r�'�I�''� � ��S.� � <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale a�d show the following as applicable: <br /> ' Property lines and street identity. • Topographic changes requiring cuts and fills <br /> • Outline and dimensions of existing and other than normal foundation. y � <br /> proposed structures. ' On•site drainage systems when required. N y <br /> ` Existing and proposed utilities. sion control methods when required. � E� <br /> • Centerline of abutting right of way. ' No h row , /� — <br /> - �5 nature al Aoo��cent � � <br /> PUBLIC WO S PERMIT � Z <br /> � <br /> � � <br /> CONDITIONS; � �, <br /> � . . . . . . .I kcct - -1-o.� c�rc+�.,�. �c .....� !- be c:o��-��oJlt•.v' o�, /�r �c '� o � <br /> � . . . <br /> i . • . . . . . . � c�. . Q��y e�a�-...nS._. .ur F�<<,. ��� �1.� ���..k+l�� �1�����1- - .,E '..��� � N <br /> � . . . . � 1 N <br /> 'i � . . . . i . . �u r �; �T�.1 v�. . v�u. �c C(a�i'�" 1'.a�� �.�"r� . Le.�t1 E bl=-. . . . . <br /> f . . _ . �.� � <br /> j ' � ' S, 10 !h.,,�,\Nr . . � � N <br /> . «pf,:�.. <br /> : � � --� ��- ��� -�;��,.� �;,,.,�.�. _ �;r ._,-,-�y . � <br /> " �_:._ , ' 3 ` ��n. . ci� � � I 1 / <br /> �i . . . ; . . . . . �',i �:�r .�.t. �.�a.>�loi-. �:�� d�� 15 dv `'� p�/ . <br /> . �ro.�.. !�1 - , . . y <br /> � .J . . . . . <-`F�itr,V µ.,Q , ,c� [t ��H. . . . . . . . . . . . . . . . . . . _ . _ . . . S <br /> . . . . . . . � � . . 1 . . Z <br /> f � � � � � <br /> a�� � �� �`��-�_ � <br /> �� � � � ' � ' ' � ' ' � G'/�/��/�S T�e undersigned owner hereby agrees to �old en0 save haimless <br /> � � �hB Ciiy ol Evefe�i �rom Bny end ell clelms lor dame8e& Cosls. <br /> � � ' expenses,or Causes ot ectlon t�et mey etlse beceuso 01 Inalellation <br /> ' - � ' � � � � antl meintenance ot ��a improvemen� or o�her ri�h4ol�wey use <br /> ' ' � � � � herelo apPlieO lor and luriher agreea to�emove sama upon nolice <br /> . . � Irom ihe Cify en0 to replece public Oroperty demaged thereby. <br /> %�-�_ -,al. 3 - j' �, <br /> ! ppp��OR CONST UCTION DATE 4CKN W DG ENTP F CONDITIONS <br /> L� <br /> APPROVED AS CONSTRUCTED DATE SI NATUR OF PLICANT DATE. <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECI'ION <br /> POST ON 259-8811 <br /> EXPIRATION—��` j `� � JOBSITE 24HRS. BEFORECONSTRUCTION <br />