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i � — -- —. —_ _ — — <br /> � everett APPLICATION FOR PUBL�C WORKS PERMI�" <br /> i � TYPe or P�int clearly with ink <br /> PflESS HARD -YOU ARE MAKING COPIES �C,8 <br /> PERMIT NO. g� - <br /> PUBLIC WORI:S <br /> � EVERE�iT,WA.IHINGTON / �LDG. DEPT. NO.__ -_ <br /> �'' - <br /> , � O'.VNER 7 AGENT DATE ._ .;�` �/K��.___ <br /> Itillis tiomes Inc. <br /> � 4PPLICANT/FIF'M REPRESENT�D __ . -_ _ _ . _.. <br /> A�E S . ?' . Bverett I;nil Way Everett 355-9492 <br /> ADDRESS _-_ _ —_._-_ ___CITY __ TELEPHONE <br /> � HEREBYAPPLIESFORPERMISSIONTO ____ Install d>_i.vcr� rJS� /c1iCc" f j'(ii��E7"� <br /> ATTHEFOLLOWINGLOCATION� <<T �L� (�t;��nr6��= �57rU%.S -SO� �/?�a�Pnf �Va S, �v� <br /> . -- -- -- ---- - - -�- <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicabie: <br /> ' ' Property lines and street identity. ' �:opographic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other lhan normal foundation. <br /> proposed strucW res. ` On-site drainage systems when required. <br /> ` Existing and proposed utilities. ' EFosion control methods when req�ired. <br /> ' Centerline of abutting right of way. � ' North 2[row , r <br /> ' � �� 'f�, �- <br /> �� ������ � �_`-l' <br /> - <br /> �:�, - - - _ _ _- <br /> SipnaNre o'Aoo�ir.anl <br /> PUBLIC WORK� PERMIT ^ <br /> CONDITIONS: <br /> . . . 'i�oo� � ��-:';- _�r � .... . ,.:�.- ,.,� ..•.�. ' _ .,,.. ��r-.:�L� .� ,, ., l!,, i .�.� i. <br /> � � � � � ii�c undeis�yned avnei heiaby agrees Io hold unA sove hnrmiess <br /> � the Gly ol Everetl ho,n any ana au Ueims lor d^maBeS, costs, <br /> � orpem:as,or causes ol action Ihal moy arise because ol Installalion <br /> , _ . , and mainlonance ol the improvemenl or other rig�4obway use <br /> � , , he�e10 0pplied (of and Iurlher agrees lo remove Same Upon notice <br /> . . � � Oom Ihe Gty and lo mpince publla property damaged Ihereby. <br /> _ _ �/ L/' � ) � �� <br /> ����,.�_ , /'Y� � ,.v� .-�/ <br /> .-q1PP. OVF� FO TRUCTI N DATF ;�ACM t� WLEDGEME�NT OF CONDITION� <br /> / ,/� <br /> //2 �� / � i <br /> , � � y�•� �_�� Il.--�� � h��� ���( � -- - <br /> APPR D - ��� DATE f� SIGNATUREOFAFPLICANT DATE _ <br /> PERMIT fS VALID FOR 1 YEAR pOST ON CALL FOR iNSPECTION <br /> 259•8811 <br /> EXPIRATION `� ��� �3 _ JOBSITE �4HF�. EEFnRECONST�,UCTIU'N <br />