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e""`"" � APPLCCATIOh1 FOR PUBLIC WORKS PE=RMlT <br /> � TYPe o!Pnnt iJcadV wi�ll ink ' <br /> PRESS NARD-YOU f,F.E MAKING COPIES $Z�� s <br /> PERhIIT NO. - <br /> PUBLIC WORKS - <br /> EVERETT,WASHINGTON I'//� O L BL�G. DEPT. NO. _ <br /> ❑ OWNER ❑ AGENT DATE . <br /> / <br /> APPLICANT/FIRM REPRESENTED __. ��US C'.I'G5 ��� . <br /> . <br /> ADDRESS _l`��' �f _C' (/(Pt7=_;iIf�LL ��'` CITY _G ��� _. _TELEPHONE �S����42 <br /> � HEREBY APPLIES FOR PERMISSION TO _ / NST/{cC ����OtiXk'e i,___ .kl���LU�q-�� <br /> - —-- �or� <br /> ATTHEFOLLOWINGLOCATION _�U �_ C�r�i ��v1� C-'UQ� S•I�° /L.�"/'�rtt-( 'iJ(/: : <br /> -� - / - -�--= <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. " Topcgraphic changes requiring cuts and fills <br /> ' Oulline and dimensions of existing and other than normal foundation. <br /> proposed structures. ` On-site drainage systems when required. <br /> ' Existing and proposed utilities. `_Erosion contro methods when required. <br /> " Centerline of abnding right of way. ' Nor� arrow J <br /> , <br /> _ �''���= - <br /> � - ,���-=-� ��. , - <br /> ignalurC �I Apouc�nt <br /> PUBLIC WORK� P�RMIT <br /> CONDITIONS: <br /> �� J � I <br /> c: ��,_� �� .1r �, ,� � , , e , F � _ , , i , <br /> �t ,�, �-4 �, .,_ � , �-- <br /> �t. . . . � <br /> ". . : _ . r _ J�� �.. . . . . . . ' . . . . , <br /> f. . . . . .. r�-i�j �/-" , _ .. _ � <br /> _ _ . .. J:'I- - . <br /> TOc untlersigned owner hereby agrees to �oltl and save harmless <br /> Ihe City ol Everell vom any and au claims for tlnme9es, coslS <br /> . erpenses,or cnuses oi action Ihat may arise because M Inslallalion - <br /> , . . . . . ar,d maintenancv ul Ihe improvam�nt or o1hM righl�ol-way use ��� <br /> � � � hetelo applied�or and lUr��et egtE05 IO femove STme upon �olico <br /> ,� � - /� Irom the Cily anl ln replace puhli: propar.y tlamaged lherehy. <br /> ��� �� / vr'� o° 2_. i- — , <br /> �A P V R TRUCTION DAfE - ACKN WI.EDGE�NTO CONDITIUNS <br /> // ^ ��i� <br /> � � ( <br /> ( =��_-' ' ��� /���--- I <br /> APPR. � O ST �1� DATE � ZCJ ���N�T RE O APPLIC�NT DATE i <br /> PERMIT IS VA!ID FOR 1 YEAR � CALL FOR IiiISPECTION ' <br /> POST ON 259•8811 <br /> EXPINATION ��'l�� f� JOBSiTE 24NRS. BEFORECONSTRUCTION <br />