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� <br /> � <br /> everett Iw�� -` ' <br /> APPLICI�r{- ION FOR PUBLIC WORKS PERMIT <br /> � I ��:� TYPe oi Print UeadY with ink <br /> PRESS HARD -VOU ARE MAKING COPIES �� � <br /> PERM!TNO. _� `� 3c <br /> PUBLIC WORKS 111 ''�,J� � � <br /> EVERETT,WASHINGTON �. // �j� BLDG. DEPT. NO.�^`�J_�OJ _ — <br /> �OWNER ❑ AGENT DATE � i_� - � <br /> _ �/-"" <br /> APP�ICANT/FIRM 4EPRESENTED _. �u�S ���✓+{IG-- .-_ --- ._ ----____— _._ <br /> ADDRESS !Zov Sc E=N[��- ?��T /YI�Q"t L �(;ITY F" ��F�TELEPHONE 3ss-�/YS�- <br /> HEREBY APNLIES FOR PERMISSIUN TO I�����_G_��i��—LL7�(X�E='`T�—��V����� <br /> ATTHE FOL�OWING LOCATION 4���J_.'1L�'�L��i�Q �S'��S " -J I7 �/('fc2lPy ( ���+�/ S�U,. <br /> Attach (ive(5)copies of preliminary plans for proposed work. Draw to scale and show the fotlowing as applicable: <br /> • Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> ` Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. • On•site drainage syslems wheii required. <br /> ' Existi�g and proposed utilities. ' control meth s when required. <br /> • Centerline o( abutting right of way. orth rrow / <br /> -- �'Z — - L— <br /> Signa ur ol AppliCanl <br /> CONDITIONS: �UBLIC WORK PERMlT <br /> � �� ., /� / _/ <br /> �t'Pn -bc�l� CclSCivir�w.�T G1�C'r-_ /3 r�_�7 ��O �,C C7rY:i�� , <br /> aZr �fC'o'�"_'7�P �l/-a�.� u3t MKsf GG C.o�-, Tio//nv o.t {�e. �� 7; <br /> 3. /�f/1/ (JA� s�a.' rt>r i�IPv�c a f �. '�/e� rs�i�.c A�/c,� OCcu�i'�n ` <br /> C7'�/C / � cG�n i ��ucf" i(:ii /iou� f' 6� .Cr✓ci�r•,fI Ia/ l/ <br /> iJ.r��4lr <br /> � ✓f'�7ris �izx ck rc.l�� /r,�l`0 /��i/i_ iC'/iv �-7 �-o.,-. �-Hi't <br /> Cu.a3 �"r'�.. r.:�.Un S.'�( /3 �,�u ��C. [`�PWn�.(/ k./.� dtr�� <br /> r <br /> J�,_ Nd J «s{- ,v�cv`�i sc�,��;� c g/�.�- o � G:,x � ,.,<: / <br /> � � �/"a'�c , <br /> The undersignetl owner hereby aB�ecs to hold ana seve 1larmless <br /> Ihe Cily ol Evereit Iro•n eny eno all clNlms tor dame0es, cOSIA <br /> expen5C5,or Causes ot.tClion t�al may BriSe bCC8u5e ol Ins�allalion <br />+, and maintonance ol Ihe improvemenl or other righ4obwey use <br /> yi� hereio apulied br antl Wriher agrecs t0 remove seme u0on nollce <br />�`. <br />� Irom Ine Cily and to r¢place public pmporty demanaA thnreDy. <br /> 7 <br /> , OVED FOR NST �� .TION �A� ACKNO DG N/TJDF CONDITIONS � -- <br /> V��� � l.�''.C, l '' f ` C' ,� �.�� __F`_'� ` <br /> „PPROVED PS CONSTRUCTED , DATE URE OF A PLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR / CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> EXPIRATION JOBSITE 2r;}iRS. BEFORECONSTRl1CTION <br />