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i <br /> " APPLICATION FOR PUBLIC WORKS PERMIT <br /> � Type o�C�����learly wit�ink <br /> PRESS HARD•`.'nU ARE MAKING COPIES pERMIT NO. O� Jy <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON ] BLDG. DEPT. NO. <br /> K�1 OWNER ❑ AGENT DATE . _�J�4J �: _ <br /> q�GANT/FIRM REPRESENTED .__ p'�'� V�J�� ��7�tJeU�. _ ___ <br /> �----- - <br /> / � �� _ � <br /> ADDRESS �5.���� ���`�-'�Lf-~�c- W� ' "'-) CITY �GiZCS l 7ELEPHOnE �'.�� -�IOc�7 <br /> HEREBY APPLIES FOR PERMISSION TO ��'-�-��—���� � • <br /> � r v� � (�J <br /> ATTHE FOLLOWING LOCATION �Jt�3 ��-��"�-a-f_�F _��,� i - -- <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 identity. 'Topographic changes requiring cuts and fills <br /> ' Outline and dimensions oi existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> • Existing and proposed utilities. ' Erosion control methods wher�-required. <br /> • Centerline ol abutting right ot way. ' North arrow <br /> ��11 ' - ,� <br /> > _�....� <br /> SigneWreo ADPlicant <br /> coNoiTioNs: PUBLIC WORKS PERMIT <br /> _-ly�! (F �-�,R_ k\�JY k.c=i\ :�,r) �t-fr �= �r i Fff4-s -,t� i�'Cw+'•��= <br /> i� . �!� Ih t�EtJCC- tT v-1iLL /3� U1� � 71-l-tL Oi,Jl��� <br /> -►c� p C-_ -r �1 s'�LL s� r � �-t-=-r.X � /�°t— �u�r.X--iz5 <br /> �X.`t'�+.�SE <br /> 1�' <br /> �t_�_._: -J,�' C��.l�r,'Q rv�.CRC-C � -yr� �.nUUC- Sr'� tG� �=-C-1�1C.E <br /> � � �` ' �,�A y' ��>� ���f'�-� c7F- ��r�f- v�r��c-� G't� SOM^�- <br /> �� I+ po,,.�-� Tt� k�-t 1 ou-� c n� A�� � s s -�C> s�ac���F,� <br /> �,�rrT�-Z V n1.-t�� �J �TK 1� �U �<S�� � �I � -��; <br /> 1'>L �c�SFr.� ��� �r� oF� I�Rtt � c-2.�f-v��-� <br /> �S�'7 _ �E3! �. ; <br /> �� ! J� � � The un0ersigned owner�ereby agrees to�old antl save harmleea <br /> ' �,! f the City ol Eve�eu rmm eny and au clalms lor dameqa4 conts, <br /> .JG� /"d� �iJ expenses,o'cau5e6 al ection' .e�mey BfiBo beceuee OI InetallellOn <br /> / <br /> [/���� J� �/LG � end maintenence ol the Imvrovement or ot�er righFaf-way uee <br /> � I �,/✓( /�LC � hereto aOPlied lor and lurther agreea to remove aeme upon notice <br /> (/-�\ � / Irom the Ciry enA lo re0�ate public property demaBeE thereby. <br /> \�C/��� ( �J' ' `' ��'��!l `��%� �� <br /> P.P Ob5 FOR CO S RUCT ON �DATE ACKNOWLEDGEMENT OF CONDITIBN£� -. <br /> � � / � � <br /> _ � ' � II V �, '�t_�� �'i I �,i-' � �.L -�=,�r �,,�•-`��.. �._. <br /> ;y li_:�._ ; �. <br /> A O ED AS CONSTRUC �� OATE SIGN�RE OF APPUCANT � DATE <br /> � <br /> PERMIT IS VALIL� FOR YEAR CALL FOR INSPECTION <br /> �/ POST ON 259•8819 <br /> j EXPIRATiON �I � `' C\ / JOBSITE 24HRS. BEFORECONSTRUCTION <br />