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� i <br /> r ' <br /> � � <br /> r <br /> � <br /> �everett pr�pLICATION FOR PUQLIC WORKS PERMIT l <br /> �YPe or orinl clearly witn ink <br /> PRESS HARO-VOU ARE MAKING COPIES ,f )/�� <br /> PUBLIC WORKS PERMIT NO. ; <br /> EVERETT,WASHINGTON <br /> f` L] OWNER f\iqGENT DATE �(' ���' �� a -7 BLDG. DEPT. NO. �a/��S�'�'� ', <br /> APPLICAN7/FIRM REPRESENTED d �'.�IV ,l I"v�' �H/ �_ <br /> ADD3ESS �-G� .'- r �-L7S_ __ y.- ---- ._ <br /> - - }� - - ---- -. . CITY /i�/ Q��v�ELEPHONE _3y 3 ^/�-7S 3 <br /> HEREBY APPLIES FOR PERMISSION TO �t-v� ��v�,� � �' � �n�,�L��` A�{µ4�C-tx� _ <br /> AT THE FOLLOW'VG IOCATION �c.� ��____�/'J_¢..� ��r,c*C�.,� ,��� ,_ � V �- -- - - — - <br /> - r <br /> Attach five(5)copies o�preliminary plans for proposed work.Draw to scale and show the(ollowing as applicable: <br /> • Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> ' Ou�line and dimensions of existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed utilities. • Erosion control methods when required. <br /> ' Centerline of abutting right of way. ' North arrow <br /> �� .L.u�.L.1�C.« <br /> $ignaiure ol FpPhcaN �--'---- � <br /> coNoirioNs: PUBLIC WORKS PERMIT � <br /> f�> :,���� � , ��� <br /> ;� ,,,. <br /> + , Os //t� ��, ��1 �,r� «�i <br /> ��'/� .��-�^ P`y�'`�� 1 e. 1 (, ` �.n �Sr�` <br /> ,� f" ��� 7��" (%I �'^ ' <br /> x`'r" � '` �\ �' <br /> C^° c�t" "' � `'" � <br /> .ry v <br /> � (e•', 'a 1 b„a' ' I S �� <br /> r <br /> ���''' �.> `� 1� I`� ,s � <br /> � �J J � �/L <br /> i �,�� �•`�. <br /> l <br /> 1 <br /> � <br /> I <br /> TM1�� intleivyned oknm �erqpy agrees lo hold anA 6ave hermless <br /> I�e Gly ol [veretl bom any nna an ciaims lor CameBes, cosls, <br /> e.penses,or cavses ol action Ihat may arisa because ol instellallon <br /> Bntl mam�enante ol I�e improvemen� or olher nphi�ol�way uee <br /> hereto apphc0 lor an0 lurlher agrees lo remove same upon nolita <br /> hom Ihe Cey and lo replace pu�lic properly Eemaped ihere�y. <br /> APPqOVED FOR CONSTRUC710N OATE ACKjJOWLEDGEMENT OF CONDITIONS J <br /> ` ___ /Ll �1 <br /> APPROVEDASCONSTRUCTED DA7E �� ------------- <br /> SIGNATUREOFAPPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON �59•8811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION � <br /> L <br /> � � <br />