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- ---— -- <br /> .� — — , <br /> i <br /> "'e`�" APPLICATION FOR PUBLI� WORKS PERIIRIT <br /> ,� TYPe Or Print claerly wilh Ink <br /> PRESS HARD•YOU ARE MAKING COPIES pERMIT NO. �� �L" I <br /> PUBLIC WORKS <br /> EVERETf,WASHINGTON BLDG. DEPT. NO. � OG3 'l.. — <br /> �ON'NER ❑ AGENT DATE �J3��� <br /> APPLICANT/FIRM REPRESENTED _ ��� - �� '�C' -- -- - <br /> <.DORESS _�1(� � �' EVC��ei� /1����" ���� CITY �vt�ET TELEPHONE 35S(o! ]/ <br /> HEREBY APPLIES FOR PERMISSION TO � v�TA� ���� ��J� ��'�'r�� �� ���UE-Zt��� <br /> ATTHE FOLLOWING LOCATION �Y �� v�'����C �TA�c�-SI�' [��/��7/�i�F l�«y SSLU, <br /> Attach five(5)copies oi 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 oi existing and other than normal four.dation. <br /> proposed structures. ` On-site drainage systems when required. <br /> ' Existing and p�oposed utilities. * Erosion control methods when required. <br /> ' Centerline of abu!ting right of way. ort arr w � <br /> Si nturo ol Applitenl <br /> PUBLIC WOR PERMIT <br /> CONDITIONS; <br /> � �oT - ��'� r��: .,,<:� � .,, .,. / � < <'�',�lra/���_I n.i '7�Ie �o�. <br /> ! , : � i : : . . . � ' , G�eak�,J t �a l��U�` i� � O. ov <br /> : �, �.�l7Y c� .,'n� t��C. . ni- <br /> / / / <br /> . . , . . . , .00f�:,' i.;. <iK,r. . !" . C'R�'r157�I�.rC �.�`''� . /N..tJf- . �i� . . . . <br /> ._ . . . � ��.�iir� /�l , a,���er <br /> � . � . . . . , .�� ' -//r�Ui-i3 ',f/�C�',K�'c( � �.i /b �rl:�c- �C, �� l.�l �m ��%�j . . <br /> s' / <br /> . . • . . . �:'v�91 f�H.C. �/Gil J. 7C' /J �C I P C'/fi:�t rt/ �"'�7 (/iN Y . . . . <br /> / � <br /> � . I. �ES/06.UCL� Or�ciP/ED <br /> � �. .:!/,¢�/� ✓A�✓E QoX NEE0,5 7a BE Gi/e/�OED � GGC—A,�1ED <br /> ; : � q c i�5,u E0 <br /> � � . . � <br /> � <br /> I <br /> '_--- . . <br /> � Thc undcrsigned awner hereby agrces�o heid a�4 save harm ess <br /> ' ' ' ' ' ' � � fhe Crty ol Everett Irom any antl au cielms lur demages, costs, <br /> - ' ' ' ' ' ' � � enpense=,or causes ol oction I�et may erise because ol inslalleDon <br /> . ' � � � � and maintenence o! tho impmvement or other riphl�ol-way use <br /> � � heralo applied for and luriher ag�ees lo remove seme upon notice <br /> � . _ ' Irom tho City antl to replece public property damagod thereby. <br /> ( !�j'�.- � /� 1. ` <br /> q¢ D ,� �(' NSTRUCTIO DATE KNOWL EMEN OF ONDITIO� G <br /> � .Q�}c"t �p-LZ-�i {,f C[' L� - �-O ��. <br /> JcP V 5 C 5T TED DATE SIGN RE OF AP LCANT DATE <br /> PERMIT IS VA ID FOR 1 YEAR CALL FOR INSPECTION <br /> F`OST ON 259-8811 <br /> EXPlRNTION JOBSITE 24HRS. BEFORECONS'iRUCTION <br />