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eV,� APPLlCATION FOR IPUBILIC WORKS PERMIT <br /> � Type or print clearly with ink �7 <br /> PRESS HARD-YOU ARE MAKING COPIES pF�RM1T NO. o�/�CJ U <br /> PUBLIC WORKS / <br /> EVERETf,WASHINGTON �nl 8, tiLDG. DEPT. NO. "'� <br /> �OWNER ❑ AGENT LATE 7__.�.- � _.. <br /> - j <br /> APPLICANT/FIRM REPRESENTED �<<�S_��7��C'� <br /> ADDRESS SPY+S�L� C7/E�P[-7I—/rJ/�LL L� __CITY _«����/ _TEIEPHONE�.J-���L <br /> HEREBY APPUES FOR PERMISSION TU I'vS%fJLL�s���/ � ��J�(f(�����Q/U�ZU/�y <br /> AT THE FGLLOWING LOCATION CD_���(/G�L���L/_1.���� S� F'Cra/n U4 SLtJ. <br /> Attach tive(5)copies of preliminary plans(or proposed work.Draw to scale and show the following as app icable: <br /> ' Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other than normai foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> • Existing and proposed utilities. conirol met ds when required. <br /> ' Centerline oi abutting right of way. + North �� ��� <br /> G1 � <br /> / S�gnal�ol Applicanl <br /> CONDITIONS: PUBLIC WORK PERMI <br /> � i, 2 L I I <br /> , ` fC'C'✓� - vc' �}y �L2,Sc.>m('�� rn.rec�. �S nol � bi CIParP�� <br /> �. �oo T ' "t'c� cl('ct, ..�a�� ��nLLS�- �e Ce.ti Tw1 �r.L o.� -�-�e �o �-' <br /> 3. ,�N �A1MctCl'. Or IOT2n.�CQ� � � �•b`�C, � �w OtG.ar\ .+` <br /> � 1 I �) 1 I a <br /> clll '� cx�.. J 't�'y�t�C .♦ .v�.nsF b¢ fc�n.(�S/ �� y.\ �Il1f/, <br /> � ✓C���S "-�'rU.c���S� i�.kv �..�i�ii. PJw -(�w..... -ti-�iC 5'.�{-2 <br /> is � b< cle���� ,.�„� �i ��, �„I , <br /> The undersignee owne� hcre6y agrees to holtl and save �ermless <br /> Ine City of Everelt nom any nna au cloims lor damaBes, cosls. <br /> expenses,or wuses ol action Ihat may arise becauso ot inslallatlon <br /> entl mamtonance ol I�e impioaement or olher righl-o4way use <br /> hereto applietl lor and lu.ther egrees lo remove seme upon notice <br /> / / Irom Ihe City antl to replace public propetly dame9etl ihoreby. <br /> �� ��'�.� 9 -s�Z- <br /> VED FOR CONSTRUCTION �IATE ACKNO GE T F CONDITIpNS <br /> — - �j��-"�--�!����Z"-- /e /�/y'� �_/0� <br /> AFPR(WED AS CONSTf7U TED 6 DATE SIG E OF APPLICANT � DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTSON <br /> POST N 25g.gg11 <br /> EXPIFtATIOfV JOBSfTE 24HfiS. BEFORECONSTRUCTION <br />