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� - <br /> � <br /> , <br /> everett appLICATIQN FOR PUB�IC WORKS PERMIT <br /> � TYPe or print tleady with ink <br /> PRESS HARD-YOU ARc MAKING COPIES pERMIT NO. ����/ � <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON BLDG. DEPT. NO._�a O� � <br /> '�OWNER ❑ AGENT DATE ._�7'cY/�.� _ � <br /> APPUCANT/FIRM REPAESENTED << IS /_F'�fC'3 .-/�tIL _ ___ _ ___ _ _ __ <br /> ADORESS OvV.'_S,���-7�C_I/�JJ/jCC_({/I'fr CITY �t"��� _TELEPHONE3��I��tL <br /> HEREBY APPLIES FOR PC-RMISSIUN TO I��SL���?S'_�f1iDF(cyv�R_r�o�R��'��A�` <br /> ATTHE FOLLOWING LOCATION CeT _ 7 IJ��RtEIUC�T/�jZ�S=S�� ���/r/��/``'�l�t S. � . <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the followiny 2s applicable: <br /> ` Property lines and street identity. 'Topographic changes requiring cuts and fills <br /> ' Outline and dimensions oi �;xisting and olher than normal foundation. <br /> proposed structures. ' On-site drainage syslems when required <br /> ' Existing and proposed utilities. ' Erosion control me ods when required. <br /> ' Centerline ot abutting right of way rro/t <br /> _ ti,_� � """ - <br /> Sign�Wr olhpplicant <br /> coNoirioNs: PUBLIC WOh� PERMIT <br /> I. �rer� - ��1} ea�e w.ewl- arca � s «o�{-' -{z, I�c c�ea,��.�! <br /> 2, �ooC- �P �c-o�,., �.�� yNKsd- be �A..�.o 11e.S' .,... -1-b.e 1 0�- <br /> J. M�y �Aw��t`4 or- �rY.ct4+�`L ya, I�.�b��� (L/w Oea.wr��.�� �ING. '�aa <br /> � V V <br /> � e.o.1�-r �..c�w•/�.� Y..w�� b� fcf+n.r�.� L��a..���•e�, , <br /> ,%ia��') ��f.Y �v�.i0 Cv��7/��)� Q/W c� V�\S QON�'�In ..♦ 5�� <br /> 1 '� � �.�. G�ta.�<-.s/ „ p 4`d��� <br /> "� <br /> � i �J�tS� Wc��/' j�i^� i �E. Uo.IY "- �o� � `t'� nr.t�/ <br /> �o-�- c1 ra.c1 e • <br /> The undersignetl owner hereby eB�Pes to holA and save hermlesa <br /> lne City ol Evereu trom eny xntl au ciaims lor Cemeges, cosr <br /> expenses,or causes ol aciion thal may arise because at Inalalla' � <br /> and mainienance ol Ine impmvemenl or o�her righl-ol�wny <br /> horeio appliea lof antl Iurihet BgreeS 10 remove SBmO ut'ai�ro <br /> Irom Ihe Cily and lo repleco Oublic pmpetly damage f the •� <br /> -��' _���i�l�--�-s�_��_L <br /> A D FOR ONSTRUCTION DATE KNOW E GE T OF CONDITIONS _ <br /> — �( ��-1p�,, !I ��3 ��� <br /> APPROVED A�CONS CTED DATE SIGN URE OF I�PP ICANT DATE <br /> PERMIT IS VALI� FOR 1 YEAR pdST ON CALL FOR INSPECTION <br /> 259-8811 <br /> � EXPI IRATION JOBSITE 24 H RS. BEFORE CONSTRUCTION <br /> I <br />