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;� _ <br /> -� <br /> r <br /> 't <br /> 1 <br /> r <br /> everett APPLICATIOI� FOR PUBLIC WORKS PERMIT <br /> �J TYVe ai�rint cicarlY wit�Ink � <br /> PRE55 HARD-VOU ARE MAKING GOPIES pERM1T NO. ��—� � <br /> PUBLI;;WORKS �1 <br /> r EVERETT,WASHINGTON BLDG. DEPT. NO.-Ilv2�U�Z-�ID � <br /> ffi OWNER ❑ AGENT DATE ////��S"oC . <br /> APPLICANT/FIRMREPRESENfED . vTe`��' . ��`"�.�''� S - - -- - - - - ---- --- <br /> ADDRESS ���'��'y���_���IST�C _UCC.IL ____CITY .�v�4flr TELEPHONE 3s-?-yS2"` <br /> �r�J rJnsT�Hc1-i�., s�n,lr _-{-n�+-+�ly c�ew<•fl�n <br /> HEREBI APPLIES FOR PERMISSION TO - ---- <br /> ---- --- - <br /> — � •—O� _ .SZ.��---- -------— ---- <br /> IATTHEFOLLOWINGLOCATION q��V _�451_f�11�ISlifZ_ 4'.�fk"tl� w��St�• _ <br /> Attach five(5)copies ot preliminary plans for proposed work.Draw to scale and show the foli ...ing as applicable: <br /> • Property lines and street identity. • Topographic changes requiring cuts and fills <br /> • Outline and dimensions of exisling and other than normal founda!ion. <br /> proposed structures. • On-site drainage systems when required. <br /> • Existing and proposed utilities. ' Erosion control methods when required. <br /> ' Centerline of abutting right o�way. ' North arrow <br /> � �`,�q.,i� a�:,s�.._ <br /> —-��'----�Siy�w�weotAPDllcant <br /> coNoirioNs: PUBLIC WORKS PERMIT <br /> 1 y ` J ..�b n��l (�.�Ne/ s�nu be ��.•11� re...�o�.�0 <br /> �. Lx1�f1�'1( JI[�f1�JC\1k y � <br /> 0.h�S' �epia�c<< •�r .ntw clfwe...«..I <� �v... T e �+�•'-� <br /> �� i <br /> �,.r6 fe�rHei Sre�.o:. �M�at br rcmu / 1 <br /> ��.52 - k„o�k,.,�-o�c' o G +l,e <br /> CNPb 1 k Pc•��.-:�He�� . �CmW�:.� oi e7�IS�IN� ���C�lwci��L <br /> 0.1� 1� HD <br /> n.+�c e�.-b $�a He� n�N�F be clo.�e � �ntG.-� :� er�r�.�s�o.-. <br /> �u� NT ur' SCtw- fwt .�-Y N(KSlCS� Scc.fP, hntlr�-. <br /> �. 5<<t w.�'. �0 1�+ b <br /> t u,..-`.vll.�� n.,� �•o'� 0.IIU\Unfl •�o c�r«�'�. o..'�o <br /> Q��R.ce..1- lowe� lo�'-. <br /> '�, r'�tl fvo� c.�aw .� clr.�.,..5 �+�e <{v 5-0 �..1< dr.' we113 <br /> � f?on����r a�e.� ir ,�.. .[r�t c%a., Rt ..'/� �..«�S . <br /> The undersrgnetl owner�ereby ag�ees to t+olE enC sara�armless <br /> Ihe Cily ol [verett bom any ana au claims lor tlamapes, cos10. <br /> e•Penses,or causes ol ection thal mey erise beceuae of�netellallan <br /> an0 mainlennnce ol Ihe Impeovemenl or ot�e� np�bo4way use <br /> herero appliod lo�antl lurt�a�agrees lo remove same upon natke <br /> Irom f�e Cily anA to �eplece puElic pmparty dam�peE I�ereby. <br /> �—' /�_�G�- // /9 � z- <br /> L ACKNOWLEDGEMENT OF CONDITIONS � <br /> pppR9VED�FORCONSTRUCTION � "D�TE <br /> � V� l� �d� S`�y�'�'� � — �—� __._ <br /> APP OVED AS CONS CTED � DATE <br /> SIGNATUF7EOFAPPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTIOi` <br /> POST ON 259•8811 <br /> JOBSITE 24HRS.BEFORECONSTRUCTION <br /> EXPIRATION— — —1 <br /> � <br /> L J �, <br /> a <br />