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,_ i <br /> everett APPLIC/'+TION FOR PUB�IC WORi(S PERMIT <br /> � TYPe or Crinl cleady with ink ��� / J <br /> PRESS HARD- YOU ARE MAKING COPIES pERM1T NO. — <br /> PUBLIC VJORKS � �g'� <br /> EVERETT,WASHINGTON BLDG. DEPT. NO.�%L L 1 " <br /> ❑ OWNER }�AGENT DATE . C� �-j �'�` � <br /> / -- - - —/- -�- - <br /> APPLICANT/FIRM REPRESENTED _.�//U2TfFliJDUO _ . � __ _.�3u/�24L _ _ _C�-0h�% ____ <br /> ADDRESS ��—�'��5�iJ/'-✓r�9A ,OyE�__ CITY �� —TELEPHONE �3�D _ <br /> HEREBY APPLIES FOR PERMISS�ON TO ._.'�L E Ey�ST/N� �2�Uf_LU,e�/�_._._ <br /> ATTHE FOLLOWING LOCATION � ��—��'�— '—"���-t-�'— —�U�---��Y'S�� <br /> Attach tive(5)copies of preliminary�tans for proposed work. Draw to scale and show the following as applicable: <br /> • Property lines and sireet identity. ` Topo�raphic changes requiring cuts and fills <br /> ' Cutline and dimensions of existing and other than normal foundation. <br /> proposed structures. • On-site drainage systems when required. <br /> ` Existing and p�oposed utilities. ' Erosion control methods when required. <br /> ' Cenlerline of abutting right of way. ' NoriJ� arrow , <br /> (/—✓_��L�1 "7��G�0-v(,t1 <br /> \ �� _]— Signature ol Apphcant <br /> t <br /> coNoiTioNs: PUBLIC WORKS PERMIT <br /> I 7h� undersi9ned nwner hr.reby rgrees to �old antl save harmleas <br /> Ihe Ci1y ol E�erett �m�� any ana au ciaims lor dameBes, eosls. <br />� e.penses,o�causes ol nction t�al may arisa beceuse ol inslallalion <br /> and mainlonance of the improvement or other righl-ohwsy use <br /> � hereto ap0lietl lor and luriher agmes to remove seme uoon nolice <br /> � �j � Irom 1he GHy and Io replace public �mporty dnme8ed Ihereby. <br /> `�-' tk� _ � �Z <br /> APPR01lED F R CONSTRUCTION DAi ACKNOWLEDGEMENT Of��:GNDITIONS --- <br /> 1�...��Jt'_�,CS.(r,c�'��—� — � �'�/G�JZ� (��C�f�,J_���c�2C.0 �'. �r��Z <br /> APPROVED AS COKSTRU�TED �-� DAT SIGNATURE Or NrrLIC NT� DATE <br /> PEhMIT IS VALID FOR 1 YEAR CALL FaR INSPECTION <br /> PO,�.,T ON 259-8811 <br /> E�tPIRATION _ � JOBSITE 24HRS. BEFORECONSTRUCTION <br />