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'� <br /> r <br /> 1 <br /> � , <br /> everett qppLICATION FOR PUBLIC WORKS PERMIT <br /> � TY�e or Print cledrly wOh Inh c._ <br /> PRESS HARD•YOU ARE MAKING GOPIES pERMIT NO. D_a�3(�'� <br /> PUBLIC WORKS �/ <br /> r EVERETT.WASHINGTON BLDG. DEPT. NO..O_.'� .�-J�S`�� � <br /> �OWNER ❑ AGENT DATE <br /> ra-3 -8v <br /> �zLC(S �lI1C3 �'�— -- -- <br /> APPLICANT/FIRM REPRESENTED - - - <br /> ADDRESSS��E_S�t��-�-��t-YT _/1_ }C. _ �VAy-. - -- CITY �VC-72ET�TELEPHONE 3�yy�Z <br /> HFREBY APPLIES FOR PERMISSION TO IN�f�I� a S�_C_UIDE_�O�'et� �=e�VtZV/� <br /> ---- � - - - --. ,' 1 <br /> _. _ ._ . _ . . . ._ . ._ <br /> ATTHEFOLLOWINGLOCATION ��—.�a�'_ ��C..PfJCE�I� E�A%2-'S_'7O3 V2cuI¢.�e yvay S.W <br /> � <br /> Attach tive(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicab'ie: <br /> • PropeRy lines and street identity. ' Topographic changes requiring culs and fills <br /> • Oulline and dimensions of existing and . On-shle dha nage systems when required. <br /> prcposed structures. <br /> • Exis�ing and proposed utililies. ' Erosion control methods when required. <br /> • Centerline of abutting right of way. h row <br /> i �. <br /> -- ` �- --iBnalwe al AOPlicanl <br /> CONDITIONS: PUBLIC WOR S PERMIT <br /> /� / / /7 / <br /> � ICJV-F _ ��J ��rd..•rc� t hw3f' EF tb..7w��ic(' OK `�`t' �'�� <br /> Z. /vn' �I,t m<�g.� n r brCnk� C � �Nb��L .PO� LU OP(l+��li� 1 Au f d`� <br /> ✓ <br /> L .�,��.n � 6:�J.��,-. <br /> CN��:-Ti�dn inrsF br' /!P <br /> / 1/ / / <br /> 3. �t��t �/lG�lt� �.� ��tfl�� I��U, vV. �IGrr 'J^if $.fG /3 � �I" <br /> C�lnnf<(� � "F'�y . <br /> /• /�OJuJJ Wa�f'/- JP/✓ii t [/F'/�t �c:v �� �Y:nn'� �or' S'/SGL'. <br /> The unticrsiqnetl owner �ereby a9recs to�ol�antl save�ermless <br /> �nc Ci1y o� Everclt trom any ana au aaims lor demapes, eoels, <br /> e�penses,or causen ol ncUon IM1at may ansa beceuse ol inslellatlon <br /> a�d maintenance ol ihe Impmvement or oi�or righ4ol�wey uae <br /> Oeieto a�Plied lor ana Iwlno� eBrees la remova 9Bm8 UpO��OIICtl <br /> Imm 1�e Cily and to r �W.e Fublic UroOorty Eemepod t�emb}. <br /> ���777 .�/�/� <br /> ��.�lS/� �.l e-PiZ <br /> L pPR V€ G CO�RUCTION DATE ACK W'�� T CON[ IS � <br /> 1 � CJ�� �Z"�a �� <br /> ��� -- -,1/_�-��3 - <br /> APPROVED AS CONSTR TED DATE 5 RE f LICANT A� <br /> PERMIT lu VALI FOR 1 YEAR CALL FOR �NSP�CTION <br /> POST N 259•8811 <br /> JOBSlTE 24 HRS. BEFORECONSTRUCTION � <br /> ! EXFIRATION <br /> L <br /> J <br />