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� <br />� <br />� <br />L <br />�°"""` APPLICATION FOR PUBLIC WORKS PERMIT ���Qq��''j]'],.. <br />TYVe or Print clea� y with Ink ��� i <br />PRESS HARD - YOU ARE MAKING COPIES pERMIT N�' <br />PUBLIC WORKS <br />EVERETT, WASH�INGTON BLDG. DEPT. NO. � ��� 3 <br />❑ OWNER ff8"AGENT DATE `�� �' f �� _ <br />APPLICANT/FIRM REPRESENTED ��� !'�/ S - .y <br />ADDRESS `� ��y �S.'•�l,���,i 4vF CITY ��� =%u=�T� TELEPHONE %1.5�5- L'c'���? <br />HEREBYAPPLIESFORPERMISSIONTO �-��-�+,i-c��.� ,�� ' -;,�„�)- �?�r,,.,: .�.-,. ,«.z <br />h:�dcJ� f/cvsf. <br />`�.�/(• <br />ATTHE FOLLOWING LOCATION '% ?^'wr� Sr _/�,� �S j .�t� � <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the followinp as applicable: <br />` Property lines and street identity. • Topographic changes requiring cuts and fills <br />" Outline 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 />� �/ 7 /: - <br />� <br />� � ,- <br />l.: 2< r, G �: ti.-.---r� <br />" SlOnature o� Aopllcant <br />PUBLIC WORKS PE�iMIT <br />CONDITIONS: <br />�.... ... . <br />� i:—� ��a : e �. a .,� . .. i �t, _ d,-,�• .ti„ <br />: ; ; ; . �;, , ��. .. �.�. . � � _. �t, _ ,2 , ��..� - ,, c - �... ., ,.� <br />. . . • . . . • '(J R V l' G`� . . . <br />I. . .–...� .. _. . ... . . . . . . . . .- . . . . . . . . <br />.. -f" <br />.. .. I <br />�. <br />. � _lnJ LLur�' �,} <br />. ..Q _ ..... � <br />r : : � : �;,�`� (��-'`�� :. . <br />I ---�. _ . . : : . : . . . : _ . . . . . � . . J <br />� �: ! ..::. ::: <br />; ... ,:. ;.... <br />, _ _ _�.__________ <br />. . . . , , .--;-. <br />.; . <br />. . . . . . . � . . . . . . . � . . . . . <br />_�.—y i iC"��—__ '$''�.2-t � <br />� �% <br />rAPPROVED FOR CONSTRUCTION DATE <br />L <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION � /j ' ' <br />w..; -. �; u ,— <br />CQ.'u,.�!.4�a.- iJ�Gr : . . <br />. _ � It�K��l��: . :. <br />: \��r. � �,`TL>:��. <br />�� ,) <br />, <br />T�e unCeiSigneG ownnr �ereLy aBreesto holtl and nave �ermleas <br />the City ol Everelt trom any ana au cie�me for Mmepea coet4 <br />eMpenses. or caunes of ecllon thet may arlee Decaune ol imlellelion <br />and maintenenco al Ihe improvamenl or ot�ar rlphlrol�way wa <br />herelo e00�ietl lof entl lurther epreoe to fBmovB eame upon nOtite <br />Irom t�e City anG In replsCe public Ofoperty dem�peE ihere0y. <br />�KNOWLEDGEMENT O� CQNDITIONS <br />�/� /� � /�/ i / <br />!� �r. �7 .� �- !_'l�c,...�L� l_�G'L� <br />SIGA�ATUFiEOFAPPLI�C1 T DATE <br />POST ON I CALL FOR INSPECTION <br />259•8811 <br />JOBSITE 24 HR,i. BEFORECONSTRUCTION <br />1 <br />t <br />� <br />� <br />41 <br />� <br />�� <br />_. <br />� <br />1 <br />� <br />.J <br />� J <br />