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_ , <br /> r <br /> .� <br /> � , <br /> everett pppLICATION FOR PUBLIC WORKS PERMIT <br /> 0 TY�e Or Piint UedriY wiln ink �i �/�— r <br /> PRESS HAFD•YOU ARE h1AKING COPIES pERM1T NO. � <br /> r pUBLIC WORKS BLDG. DEPT. NO.. ����`G �- <br /> EVERETT.WASHINGTON ' � � <br /> �WNER ❑ AGENT DATE �- �i '/ L <br /> APPLICANT/FIRM REPRESENTED �ILL�S ./16'�nC� 'f"'�' � - - � � - -� � � <br /> ADDRESS -U`��-J���` . ��n�"7T ��1��� . .��Y. CITY �-�����TELEPHONE �� ��� <br /> HEREBY APPLIES fOR PERMISSION TQ ��'!'5���"- ���/-�r��(�N��f-T���V�'�� <br /> - -— <br /> ._--- --------- <br /> - <br /> ___._ ._. _- ---- -� - .. /.� <br /> A1 iHE FOLLOWING LOCATION _L<���- �f��-/�Ne—�S������5-5�5 [�r Qvle ��•�vF <br /> Attach tive(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> • Property lines and street idenlity. ' Topographic changes requiring cuts and fills <br /> • Outline and dimensions of existing ard . pn•shle dra nage systems when required. <br /> proposed slructures. �ant ol m hods when required. <br /> ' Exi:�ting and proposed ulilities. • North rr <br /> ' Cenlerline of abutting right of waY / <br /> (.,7 /� �k_ - <br /> -- - -- Sie�N'u'e oi Avoiiwnt <br /> CONDITIONS: PUBLIC WOR S PERMIT <br /> �� � ii CQ SC�.:(✓�7 F:r'l0. �t �7 '7� `.�[+ C�G� rr..� <br /> / ��`eP,� -/:� (� / /� / <br /> �. �oct -/�l' �t"�r�a� t /�7K5�- �✓F t'vn�//t<` o� �� /v7- <br /> 3. /�7� 4�Iixs � Ur a/'Y4/v���. � �e6/iL �/W OfCu�-�.,-.� r <br /> �c p� 3co s�.�Y��� n,r>>•�- 6e. /-�P.�,���'l� �,%lti, <br /> � <br /> ����� ���.E,tO.,;,� �.�� �/��,� �r s,� <br /> /r �, .li r <'�C�i�ll� � 9' � ���`_l`>' � <br /> s �,�. ,��- .��,� � ��� ��°�k � �.,� n � <br /> Tnr undersiyned owner�e�eby ag�ees lo hold an0 save�ermla55 <br /> Ihe Cily ol Everelt Irom eny ena eil claims tor dameBes, cosls. <br /> eepenses,or causes ol aciion Ihat may arise Docauso o�����allalio0 <br /> e�d ^ainlonance of Ihe �mOmvemenl or ol�er nqh4o4wey uso <br /> �ete:�2ppliuC lor and IutlOor 2Br fe9 10 re�nUv¢snm8 upOn nOIiCB <br /> hr..n Ihe City enE tn �eplace pu:�lic pro0an Cemeged ��oreby. <br /> —� y� <br /> L / <br /> p� R CONSTRU�'TION D ACKNO LE,qGEM OF�ONDITION` -- J <br /> J �1�� �� _ r�. L�— <br /> APPROVED AS STRUC D DATF. SI3 ATURE OF APP. CANT �'�TE <br /> CALL FOR 1—T��� <br /> PFRMIT IS LfD FUR 1 YEAR pOST N 259•8�11 <br /> JOBSITE 24HRS. BEFI?RcCO.`�STRIICTIGN <br /> L EkPIRATIUN - <br /> " J <br />