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everett <br /> � APPLICATION FOR PUE3LIC WORKS PERMIT <br /> Type or print clearly wllh ink <br /> PRESS HARD-YOU ARE MAKING COPIES �,� �- <br /> PUBLIC WORKS PERMIT NO. � �-' <br /> EVEFiE1T, WASHINGiON l" � <br /> �Q OWNER ❑AGENT DATE u � Z BLDG. DEPT. NO.g �s� "� 'I <br /> � ., / <br /> APPLICANT/FIRM REPRESENTED �LLtS /-pom6 r� <br /> ADDRESS �7-(v 5�E Ec/E�� /n�L �V��L—_CIT/ E�E�C� TELEPHONE.3SS'"S��I�/Z <br /> HEREBY APPLIES FOR PERMISSION TO �N�RL�- � � � <br /> o��__"�'C� CrINC�PETE �QI(/E'uJf{�/ <br /> ATTHEFOLLOWINGLOCATION ��7� Sa- I�E�Ac�/� E�i�Jr�S-5o/ ����,,��;;r LL'<<,, � L', <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to:.cale and show the following as applicable: <br /> ' Property lines and street identity. ' Topograpliic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other than �ormal foundation. <br /> proposed structures. • On-site drainage systems when required. <br /> ' Existing and proposed utilities. * ' n control met ods whe equired. <br /> ' Centerline of abutting right of wa;. ' Nort arr w <br /> �L- <br /> ignat c ul Applica <br /> PUR�.IC ti�VARKS PERNiIT <br /> CONDITIONS: <br /> I . . <br /> � / / J / / / <br /> ._ . . /. OU�7c> �! ti, i ��_ <' via�5f �� [�i., ir: �'� h � <br /> �" f' . � / / �� l c.>.. � c- c T <br /> . . � <br /> . . t��• /4�./! <�:�iri e✓�'C . t.�i �J� .' ��•';S<: /c: ��( ��/c �,U.L-i_'. <br /> L .. -.-._ _ ' �, /" [ . . . . / � . �/ <br /> � . .. . . . OL�c^u� .l�i'y5. �./(Ctt, / ti c:i,n��7��-ac-r�io .� ' ir�u�SY b �'_. . . . . <br /> , . i . . . ; /i�f:7:,��.�,3t/� U•; �7;r.' Gu,/�/,- � . . <br /> �/�(yl / 1 / / ) / -, / <br /> ._. . . . � .�• �.�% " t7: 1S �'�/CCCF�"�� ;rl/ �C[ U�i<_� /l�C�. L/�� -�rUr.-, � )/..f . . , . . <br /> . .� . . . . . . . C!C)/�S7/ u.'• �iC%.-j .7: ✓P /3 J/i� 6e' <'�F�iifc/ <br /> I . . . <br /> . . . lt�J' �T'./ • <br /> �. i���2 J��vr.- �ox n)�C—D5 'i[� ac <br /> �Z�DED � G�.-�h.FJEI� � �L� Ct� C—D <br /> � ' �� - � � � The undersigned owner �creby agrees to hold and seve harmless <br /> � • � ' � � Ihe City ol Evaretl �rom any ana au cialms lar dnmeBes, costs, <br /> ' ' ' ' expen5es,or tauses ol a�;inn thai mny arise berause ol inslallalion <br /> � ' � - � ' - � � � ' ' and maintenance oi the improvemenl or other riyht-ot-way uso <br /> � � � . � ' - hereio appliBA lor and�urthHf OQtoeS�0 femov9 58me upon nullCo <br /> � � �� � � � Iram !he Cil and tc replaca <br /> .�L�� 3_ � Y public property damaBed I�ereSy. <br /> / <br /> ,��- '-d.'� - 7- z _ <br /> �APPROVED FOR CONS7RUCTION DA E 'ACK WLEDGE NT F CONDITIONS , I <br /> 9 J <br /> -�I �;r , , �CS., �, ;,_ ��j � � <br /> ���� ���C`�:s - �;' �=,_ � � ,_, /� �•, 1 <br /> APPROVED AS CONSTRUGTED �� DATE �/ SI�ATURE OFAP,ALICANT DATE <br /> P�:RMIT IS 'JALID FOR 1 YEAR C:ALL. FOR iNSPECTION <br /> POST ON 259-8811 <br /> ' JOBSITE <br /> EXPIRATION_ ' - 7 - � � 24 HR�. Q�FORE CONSFRUCTION <br /> a <br />