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I <br /> °`�'�" qppLICATION FOR PUBLIC WORKS PERMIT <br /> � ivoe or o�+m nearry w�m�nk p <br /> PRESS HARD•YOU ARE MAKING COPIES pERM1T NO. 0'1 a S � <br /> PUBLIC WORKS <br /> ��=VERETT,WASHINGTON p BLDG. OEPT. NO. <br /> ❑ OWNER ❑ AGENT DATE�_p -_L7�-�Zi- <br /> APPUCANT/FIRM fiEPRESENTE[J"�—�1/O-t1_uL�_-�CJ-'�f-�1��e-f <br /> ADDRESSx ��7�O� tY �s Z N�/,�- ciTv ✓ " \ `r' TELEPHONE �j� ' S S 7/ <br /> HEREBY APPLIES FOR PERMISSION TO USe �y� e S <br /> ✓ <br /> ATTHEFOLLOWINGLOCATION a UI ��- Z O �b /1 �* c-�f Q''' <br /> Attach five(5)copies of preliminary plans(or proposed work.Draw to scale and show the following as applicable: <br /> • Property lines and street identity. •Topographic changes requiring cu� and fills <br /> • Outline anr,i dimensions of existing and other than normal foundation. <br /> proposed structures. • On-site drainage systems w re�4uired. <br /> • Existing and proposed utilities. ' Erosion c s en �equired. <br /> • Centerline of abutting right ot way. • No o , <br /> � <br /> gnelure ot AoObuN <br /> CONDITIONS: PUB�.IC WO KS IT <br /> _... .. .._f. . ;-...,. <br /> � <br /> . . ..._ . . _.__.__L,..._.�.�._.. _.__.._._.. <br /> ... .. . . . . ....,_�_.._1...' . . ._�._i_ ._.t ._. <br /> ..._.....a- .... �..i . . <br /> . . .. ._... . . ._. . .._._ . . . . <br /> • <br /> TM1e unEers�gneE owner hereby agrees lo hoiA and savN 1lermleu <br /> Ihe Clty o� Everett vom any ana au Waime lor OameCea, wate, <br /> eRp¢n5es,or wuees o�acUon�het mey efife beGuee OI in�ldl�tlon <br /> antl mamtenence ot t�e Improvement or ot�er np�lro4wry uee <br /> �ereto appbed lor and lun�er agree�lo remove e�me upon nolke <br /> hOm I�B Ci�y anC lo reGlata pub6c pmperly EamapeE tAeroby. <br /> / �� l��Z. - �- <br /> �� VED FOR CONS UCTION DATE ACKN EpGEME FCONDITIONS <br /> ,%:--��_�+.---- 3� 7- y3 L��'�� � � y�j���— � <br /> AP ROVED AS CONSTRUCTED DATE GNAT E O APPUCANT OATE � <br /> PERMIT :S VALID FOR 1 YEAR CALL FOR INSPECTION '! <br /> POST O 259•8811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION <br /> I _ <br />