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� <br />everett APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYPc or nrinl cleady wil� ink <br />PRESS HARD • YOU ARE MAKING COPIES /, � <br />PUBLIC WORKS PERMIT NO. "� U <br />EVERETT, WASHINGTON BLDG. DEPT. NO. ��E '� <br />�:OWNER OAGENT DATE __ �_�__ � ` � � <br />APPLICANTiFIRMREPRESENTED _���� '4ij� J�_.�_ �'°I`/`���N�C_N����i':e , � <br />._8_--. _! CNv4 __ _. . _ . __f.'._--__ <br />ADDRESS I'_�l'' 1"� �^ �'ti"��7 1 I��_ i�lLl'� L%-a CITY r � f R E7 T TELEPHONE 2S 2' ��/Sc� <br />HEREBY APPLIES FOR PERMISSION TO .-��'- � t='� � r( A<<E y� `o� �- ��i�� !''��ti' /� /�[ <br />ATTHE FOLLOWING LOCATION _�_L. _ �_ � '�� N'i_ l __ _ ___ _ <br />Attach tive (5� copies oi preliminary plans for proposed work. Dr;iw to scale and show the (ollowing as applicable: <br />' Property lines and street identity. ` Topographic changes requiring cuts and fills <br />` Outline and dimensions o( existing and other than normal foundation. <br />proposed structures. ' On-site drainage systems when required. <br />' Existing and proposed ulilities. ` Erosion control methods when required. <br />t Centerline oi abutting right of way. ' North arrow <br />� � � <br />-- +r=� : ji: Ct-/ <br />� 5ignaWroolApplicant <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />�\< . .._,�� <br />��� � � ( <br />. . . �' C � O 'oS -�-yi F <br />I 1 <br />t-i. > : . .. . � �> <br />�_ � .- � �. I . � � _ ��� . �- <br />'Y� b e e x l S-[ � � N r�) <br />�io �n � a, c � � '? �.. <br />l .- i ' � . � G• • i "� � . <br />� <br />; ; ,, � � I <br />S i c� P L..� .r. ( ���_ <br />�' �� �� i _ �., ��_ <br />the undeis�gned owner here0y a9rees lo hola pnd save hermless <br />Ihe Gitl' of Gvureu ucm any ana au Uaims lor damapes, wsts. <br />eapenses, or cxuses ol action that may nrise bocause oi intlallation <br />antl mainlenance ol Ihe imOrovemenl or other righ4obwey use <br />herelo applied lor and lurt�er agrees to remoce same upon nolico <br />Irom the Cily antl te replace Oublic pwperty dameged t�ereby. <br />._- �- / `,�- ,{"% <br />A�T,Er ACKNOWLEDGEMENT OF CONDITIONS <br />--. %� �' � Z �- - �-�' ���.(-� C - <br />� <br />DATE SIGNP.TUREOFAPPLICANT DATE <br />PERMIT IS VALI� FOR `f�`_'EAR I I CALL FOR INSPECTION <br />POST ON 259-8811 <br />EXPIRATION �' �' y��k Z JOBSIiE 24 HRS. BEFORE CONSTRUCTION <br />� <br />