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1 <br /> everett qpp��CATION FOR PIJBLIC �II���K� PERMIT � <br /> �� TS'Pe or Ptint clear�Y wilh ink �j Z � p . <br /> PRESS HARD -YOU ARE MAKItJG COPIES pERMIT NO. _ <br /> PUBLIC WORKS , BLDG. DEPT. NO. ' <br /> EVERETT,WASHINGTON <br /> ❑ OWNER ❑ AGENT DATE _ �/I�/�Z- -�[�/, <br /> ���(L l ] i I�)yl E S .Tit�C' <br /> -- -- <br /> APPLICANT/FIRM REPRESENTED _ _ _---- -----� - - �- ������' <br /> G��' :� El�LnE7Y /l/�}GC LU��CITY �VG�Z�� TELEFHONE���—��� <br /> ADDRESS C'� <br /> HEREBY APPLIES FOR PERMISSION TO /^JS7�1�� �s� ����Rt�` �h� `/t��r, <br /> -------_ - <br /> - - -------- -- - Lor iz3 <br /> ` � '- -!�.�r�it�t�t i_:���� <br /> AT THE FOLLOWING LOCATION _�L 5_—UL�-'��PN e�ar— -S, �\ <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as app�icable: <br /> • Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> * Outli�e and dimensions of existing and <br /> other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed utilities. ' F.tns on control ethods when required. <br /> " Centerline of abutting right of way. fNorth rrOw <br /> \_—J��� ! �s���� — — — -- — <br /> / Sig a�ure ol AODlicanl <br /> PUBLIC WORK� F'E��VII'� <br /> CONDITIONS: 1/ <br /> I�OOT �1V � � � ct �nu �c'_ ��,LIS � bf CO.����r3` cn "" <br /> , . . . . . . �� 10T <br /> ! ' _.. . . . . . . . . - - <br /> I ,` . . �. � . . � . . . . . . . . � ' . . . . . . <br /> I...... .... .... .. . . . . . . . . . . . ' , . . . <br /> I . . . ,. . � ' , . . . . . . . . . . . . . . . . ._. ... _ .. <br /> i '_' . .. . " . �. . . . . . . . . � <br /> . � - ' ' ' The UnderSi�netl ownm hereby agreCS�o h0�d nntl SavP h0�mless <br /> Ino Cily ol Er�rett trom any ara au ciaims lor damages, coslr, <br /> expenses.or causos ol action t�nt may arise because ot instullalion <br /> antl main�rnenca ot ihe �mpro�nmon� or othe� d9h4obwa� usc <br /> � herelo aPP��ed lor and lurlher BgreBS lo fCmOvo SBme upon �olrco <br /> � I•o1n �hc Cily and to replaCe puDliC propehy damaged Ihereby. <br /> .ti� f/ - ' • �� fZ� � <br /> � ��- DATE / �ACKN�V�VLED�MEyT OF CONDITIONS <br /> �A OYEffF R ONSTRUCTIO =� � ( � -- <br /> /¢- � _ z� �\ i/�4� 4 !� ��l�,l . <br /> (�S' �_1�--- ��-�_ __.—I- §li3fQAiURflOf!APPLIGANT DATE <br /> APP V C NS RUG ED dATE , <br /> rALL FOR INSPECTION <br /> PERMIT IS VALI FOR i YEAR pOST ON 259-8811 <br /> /.,.,�,. ,F� JOBSITE 24HRS. BEFORECONSTRUCTI�Dn <br /> EXPIREITION ' <br />