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r - <br /> I — I <br /> everett APPLICATION FOR PUBLIC WORKS PERMIT <br /> I�e <br /> Type or priM Uearly wdh ink <br /> ` PRESS HARD•YOU ARE MAKING COPIES �3� <br /> ?UBLIC WORKS PERMIT NO. <br /> EVERETT,WASHINGTON 7 / � <br /> BLDG. DEPT. NO_�� ���7 <br /> � �OWNER ❑ AGENT DATE I ��/�j_ <br /> APPLICANT/FIRMREPRESENTED .�L�"_�S_._./"7�'r1E"� �G-__ <br /> ADDRESSII�_�'_S� �__C✓L.72C:r! //'1/}C� �(f�y CITY E��'R�7 TEIEPHONE�SSy�ISZ <br /> l <br /> HEREBY APPLIES FOR PERMISSION TO fN�L r�S� l(�/,/�-�_[�/U<�CG7� �/�iqy <br /> ATTHEFOLLOWINrLOCAT10N �E'� /aS vG.�IlC�� t'3�Tt1_�tS —�i�� /��[j �e_�i� SGU, <br /> Attach (ive(5)copies of preliminary plans for proposed work. Draw to scale and show the foliowing a�licable: <br /> " Property lines and street identity. ' Topographic changes requiring cuis and fills <br /> ` Outline and dimensions of existing and other than normal toundation. <br /> proposed structures. ` On-site drainage systems when reyuired. <br /> ` Existing and proposed utilities. ' on control ethods when required. <br /> " Centerline o( abutting right of way. ' Nort a�ow�� <br /> _— � nature ot Applicant <br /> CONDITIONS: PUBLIC WQR .S P�RMIT <br /> ,• <br /> �. �/PPr � �.JP/} r� PRSCI'�aPnf C.�Pn if ncf � (if C�tRrPc� <br /> �. /fOl�� l�/7 !7/Ai/�R, f /��N3f 5� �n �/G��r.Y C.. 1��'C �OT' <br /> 3� .Y�KI I iVI�-1Ci SP�✓/C P L'n�v C' �u v � �n�� /c� T/iar� <br /> Thc undersignetl owner nereby agrees lo �old antl sev^ qarmless <br /> ine Cily ol Evereu trom nny anu au ciaims l.r dar�ages, cnsls. <br /> expenses,or causes ol aclion Iha1 mny arico bocause o'inslalla�lo�� <br /> entl mainlenance ol I�e impmvemr.nt or other right-obwey •. <br /> hmelo apPlied br anA lur�her eprees to ramove Sam¢ upon nc � <br /> '/ e Imm t�e Cit; ene lo teplace public propetly tlemepetl iher. <br /> ��"�-5��.�.1-3-r 3 ^. <br /> / � <br /> PPROVED F CONSTRUCTION DATE / ACKNO LE4GEMEN7%�OFCONDITIONS _ <br /> p n <br /> 1 <br /> — � l �D- � ���cY ,,,til `���S�t?_ ':� % �-� <br /> APPROVED AS CONSTRU TED^ �� SIGNATU�APPL ANT DATE/ <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTION <br /> JI�BSITE z59-8811 <br /> I EXPIRATION 24HRS. BEFORECONSTRUCTION � <br />