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_ � <br /> r <br /> '1 <br /> - . _ �. <br /> - - -- --- - - � <br /> "'°"" APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYOe or Grint clea�lY wit�ink <br /> PRESS HARD-YOU ARE MAKING COPIES pERM1T NO. T� / •� z <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON BLDG. DEPT. NO.— <br /> r ($OWNER ❑ AGENT DATE _ �—<<u:��M - � <br /> :' � . — <br /> ,- "'.''-._ �� l''Y� /- U ,�� RPr? i_��� <br /> APPLICANT/FIRM REPRESENTED .--ri��--�— ! -�-- -- �- --'--- --- -- <br /> _ <br /> ADDRESS �73 � � �-a �� /� �7 LtJ —CITY __� /�n� —TELEPHONE 7��' � �� ��2.1 <br /> HEREBY APPLIES FOR PERMISSION TO �/ U+� 5%�' ��_i—_.'� l c � GrF ��- ' " �✓'�"14 '� < � �`%, <br /> ,_ � <br /> ' 1��� —.—� ' �.� ---- <br /> - , Er�,�//%:� 9,9zc/ <br /> AT7HEFOLLOWINGLOCATION ���%- ��'�^���v��---�--- <br /> Attach tive(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> ' Property lines and street identity. ` Topographic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other than �ormal foundation. <br /> proposed structures. • On•site drainage systems when required. <br /> • Existing and proposed utilities. ' Erosion control methods when �equired. <br /> • Centerline ot abutting right of way. ' North arrbw <br /> i - . / ' <br /> . �- <br /> � —%f�— �SiqneWreolRpplica � � <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> , . <br /> � . � . . . <br /> I : : : : : : <br /> � . � <br /> � , <br /> . ; ; <br /> ; � � : . <br /> , . . . <br /> , : : <br /> • �"' ' ' � ' ' - ' � Tha unAersigneE owner �ereby agrees to�oIC ana seve harmle6a <br /> ' ' ' Ihe Ciry ol Evereu irom any ana au cie�ma lor Cemepeq coeta <br /> ' ' - e.ne�ses,or couses ol ac�lon lhat mey erise bacauee ol Inetsll�lion <br /> ' � � ' anC mumlonance ol Ihe improvement or other ri0��•ohwey uee <br /> . �orelo apPli¢C lor antl luriher agreee lo remove same upon noUee <br /> , , Imm Ihe Clty nnd lo repince public property EemepeJ Ihereby. <br /> :.. � <br /> � <br /> =G �� �--- =' %;:;�:�:f _y <br /> L AP� OR C N TRUCTION � D T ACKNOWLEDGEMENT OF CONDITIONS � <br /> � I l,z,�3 <br /> APPROVEDASCO ST i:TED DATE SIGNATUFEOFAPPIICANT DATE <br /> PERM17 IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> PCST ON 259•8811 <br /> EXPIRATION ''��� F' S— JOBSITE 24HRS.BEFORECONSTRUCTION <br /> L � <br /> � J <br />