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� 4 <br /> � <br /> ._ " __ __ __ - __. _ _.__ _ __ _ _ - � _.__. ._� . `___�__-_ _ _ -. <br /> I <br /> everett APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPe ar Prin�clearly wilh ink <br /> PRESS HAHD-YOU ARE MAKING COPIES <br /> PUBLIC �NORKS PERMIi NO. � a' °2� <br /> EVER�Tf,V✓ASNINGTON BLDG. DEPT. NO. �� �� <br /> �F.;OWNER ❑ AGENT DATE «�� /I�� <br /> APPLICANT/FIRM REPRESENTED _�7 «-I S U//7ES �/I,�G <br /> ADDRES3 �%=G' `�,E. E��t.rr` /YI/aC� a�i�y cin- Eva�^crr TELEPHONE_�iJS -yy `iL <br /> I <br /> HEREBYAPPLIES FOR PERMISSION TO ��iSi^L' 2a L�[7E �C1�1/�/;C�TE % 1��1VC:u/A}' <br /> ATTHE FOLLOWING LOC/,TION LOT �(r__1���,?C r��C /= �,�r - << ; /S/,3 �ra��p� �(.7�t/ <br /> T �n �v o <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br /> ' Property lines and street identity. 'Topographic changes requiring cuts and fills <br /> * Outline and dimensions of existing and other than normal founda;ion. <br /> proposed structures. * On-site drainage systems when required. <br /> ` [xisting and proposed utilities. ' Erosion control methods when required. <br /> ' Centerline of abutting right of way. ' North�row , <br /> 1�� � :-��� !�'l� � � ,L<<: <br /> Signs�ur fApplicent <br /> PU�LIC WORKS PERlIAIT <br /> CONDITIONS: <br /> , / ,• ,2 � <br /> / �rPen. "/..�=1� " ; ��QSP irPw� arect / 5 noT dv bP_ <br /> I _ . . _ <br /> I . . . . �.�tQre�� <br /> �---- . . - �•. . J70U � "�� .Cl�a.�, a� e wr K a f�F GOn tt�c� /���b,y <br /> � � � �t /� <br /> , <br /> , _ . 3 �y . .�q,.,- 43 � �� .b��d,�US< �/ R.6/.� iPo. c�. <br /> � . . . � . . Otd//,�si.� � �l'G'c'_ � CvnJJ-/�+.c�i�'n �/yJNJ}" ljC � <br /> � . . . . � �, l��:�/�/ <br /> l'l��r.i�� <br /> � �.. . . _ !• . ✓E'L�i�J �j71,2��/n'�q ��a'Tc /7�. fiv. y�i.— d�li-f, <br /> l.. : ' : : �;o/n�sj�.-�.a�., s��t� . s �� de c�N,-�� <br /> ! - -.-_- - : . �r'a�,/y. <br /> / T�e undersigned owne� hereby agrees lo hold and save harmless <br /> ' � • ' ' - � � . the Cily ol Everetl Irom any and an cleims lor dameges, costs, <br /> ' - ' ' ' ' ' ' � expenses,or ceuses of aclion ihal mey arise because ol Inslellation <br /> ' ' � ' - ' � - ' - - � - ' � � and maintenance ot the improverr�nt or othor riph4obway uac <br /> hereto aOPlied for and lurther agreos lo romove seme upon notico <br /> Irom tha City and lo roplaco Oublic propetly AemBBed ihereby. <br /> . ./ ____�- O J .�Z� �-- <br /> , ROVED FOR C NS7flUCTION DA - ACKNO LED�iEMEryT F CQNDITIONS <br /> _ �— ��a� ' ��f .�3 � �� /� �c�'� < `;, ;�� �1 ; <br /> APPROVEDASCGNS CTED DATE SIG ATUREOFAPPLICANT DATE <br /> PERMIT IS 1f:�lID FOR 1 YEAR CA�L FOR �NSPECTION <br /> POST ON 259-8811 <br /> L EXP(i��4TION JOBSITE 24HRS. BEFORECONSTRUCTION ' <br />