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r —__ __ _ <br /> �"" APPLICA?'ION FOR PUBLIC VVI7RKS PERMIT <br /> � TYPo or Ptlnt clacdY wUh ink <br /> PRESS HARD•YOU ARc MAKING CO?�ES pERMIT NO. �a��� <br /> PUBLIC WORKS Q� ��6d <br /> EVERETT,WASHINGTON BLDG. DEPT. N0.1� — --; <br /> �OWNER ❑ AGENT UATE �- ��g� I <br /> APPLICANT/FIRM REPRESENTED �LUJ ��� / — <br /> ADQRESS 0� S'C c��'��m� �=���C�N G�C���TELEPHONE��-���� <br /> HEREBY APPUES FOR PERMISSION TO iNs�« as' GU/<� �R�v�� <br /> ATTHE FOLLOWING LOCATION � � EQ�rLC�IJC �57��' SO3 c�IPne IA/av J•� <br /> / <br /> Attach five(5)copies o`preliminary plans(or proposed work.Draw to scale and show the lollowing as applicable: <br /> � Property linrs and street identity. ' Topographic changes requiring cuts and fills <br /> ' Outline ?^�d dimensions of existing and other than normal toundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> • Existing and proposed utilities. " Erosion control me hods when required. <br /> " Centerline of abutting right of way. ' ar� / <br /> W <br /> Signat e ol ApplicaM <br /> PUBLIC WORK PERMIT� <br /> CONDITIONS: <br /> ��. �. �. �. � . /1�Uo t- 7v� c�i.�...efc . n,Ns / Gc: . a�n7�i'o/�i-/ oh �f,� /c f . . . <br /> / L / � . cv o cru�i.. <br /> � . a?. . �� dG'irc�� nr ✓/"Parko�� � !u �✓ � ' . . } <br /> i . . . . . . . . . . /� . �. . . . . �..cTio^ .«us J �7e �PO<r�/P� � ���.i �r/ll � <br /> r��+'e eb., s�' / <br /> �� / / � /.'O .Gu. �-��' fLii� <br /> / /��6�iF 7iacK ! /n� CkGII4 <br /> . . . .�.• -y <br /> cx+Ns f'r..c�.o�, s.v�e �r � 6� �/r�r.� i� u� c,�o,� ,• <br /> , <br /> � /; : . i��n��F ���' . �I��/,c':r�F AIRC�TS cc��� j-�,� 7v . . <br /> :s//J"r."c��4L!< �+` /I�'1S �:�7 �.'7���� /,,J�;/� �� i3[��c_ n L'P <br /> if�C`�E <br /> ,2 , �r �_S, C�cc uvl�i�C <br /> � � � � � ' ' � � � � The undei;qnad owner �erehy agrees lo hold and save harmless <br /> � � - tne Cily ol Evar.0 vom any ena au Ua�ms lor dnmages, cosls, <br /> expenses,or ceuses oi eclion IOat may erise bocause ol instellalion <br /> and mainlonenc�+ nt Iha impmremunl or olher riq�l�obwny uso <br /> � ' herelo app�ied t�r and lurther agmes to iemove seme upon nolice <br /> � / Irom Ilio Ciry anC to replace puhlic pmDorty demeBed lhereby. <br /> ���c� .�_�/ - s�/S'-�'z-- _i <br /> P OVED OR C NSTRUCTION DATE ACKNO�'l D M T OFj�"C DITI NS <br /> � � �C�� ,�', ' ��, -- �'�>/,� ,.r; 'C� -_ �,-1�"'�d <br /> APPROV O CONSTR CTE� DATE � SI - RE OF P ICANT DATE <br /> PERMIT �S VALID F�OR 1 YEAR CALL FOR INSpECTION <br /> POST N 259-8811 <br /> JOBSITE 2qwRS. B=FORECONSTRUGTION <br /> EXPIRATION <br />