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� <br /> - - - - - - - - - -- - -- _ --_�- <br /> r <br /> i � <br /> APPLICATION FOR PUBLIC WORKS PERMIT <br /> � ryoe or vrint cleatly with fnk ` <br /> PRESS HARD-YOU ARE MAKING COPIES � <br /> PUBLIC WORKS PERMIT NO. a�- �3 L- <br /> EVERETf,WASHINGTON <br /> '— ❑ OWNER � AGENT DA7E � �?'7� ir '� BLDG. DEP7. NO.�r� <br /> APPLICANT/FIRMREPRESENTED _�/�__J�or-i ,� �.7�_�fr�eMr,cl� <br /> �3 i y � a-�si St. <br /> ADDRESS 2 Z � ; Ivt��j�dL r_ �T I. I CITY LV<v4�� TELEPHONE 35"3 -`11 YS� <br /> HEREBY APPLIES FOR PERMISSION TO �Si4S,e .�Jri f �,l fo�� ` <br /> tiaN�,�., <br /> ATTHE FOLLOWING LOCATION Z � / 3 /,. T�1a�. r <br /> Attach fiv�(5)copies of preliminary plans for�roposed 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 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 /> 1l � <br /> z�.,;GG ' . a� � � . 'G <br /> Signeture of Applicant <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS� <br /> _ . _ _ _ _ . _ _ _ . . . . . _ _ <br /> I . . . . . . . . , . . . . . . . . . <br /> ; . . . . . . . + . . . . . . . . . . . . <br /> , . . . . { . . . . . . . : . . . . . <br /> ; � , L . :_ , . ;_,_: ., � . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . : <br /> � . ' � I . . ' . . � . . . . . � . . . . � . . . . . . . . . . . . . . . <br /> . ; <br /> , . i <br /> I . � . . �. __�-�_. ; ..i...-� i-... -y • i-» <br /> ; . . __. ._«-.-. . . _....-.__ _' . . . . . . <br /> . . . � . � . . . . . . . . � . . . � . . . . . . . � ' . . <br /> � . . . . � . . . I . . . j . . . . . . . . . ! . . . � . . � . i . . <br /> , . . : � I ... ..� • ' 1 ~ . . . . . . � �. .. � _ ;_ . . I ._ , . .. � ... .: . . : . . . : . . . . <br /> I { . l . i - . . � . . . . . . . . . . . . � . <br /> . .�_. : . .. { . . � . . . . . . . . . . . . . .-.-+�__._�..—.`.. �._.._...'___• � .� . � . , l . <br /> I . . . � . y_� � . . � . . � ..-.._f..���. . � - .�" , -�--. -�-�_ � . . <br /> � . . . . . , � . . I � . . � . . . f� . r _ , ' ` . . . . . . � . . � � . . `i <br /> � . . . . . ' _ - �- -�----_�__.,1.�.�--1---,�.1__ . . . . . . . . . . <br /> . . . . . . . � . . . . . . . . , . . . . <br /> � � � . . <br /> , . . . . . I . . . . � . . . � . . . . <br /> . . .. _-?_-----1-----.-���_�-.-�._�_-. . . . . . . . <br /> � � � � i : : -- r . � . � : . � j � � . . . . The untlersignetl ownei hereUy agrees lo hold anA seve harmleas <br /> : I • : . � the City o� Everelt trom any ana au ciaime for tlemeges, coels, <br /> expenses,or causes ol action that may ariae bacaune ol inele�letlon <br /> ' ' ' ' " ' ' ' ' ' ' ' � ' ' ' ' � � � - � � � � and mainlenance ol Ihe improvement or olher rlghFo4way use <br /> � � - ' � - ' � � hereto appliecf lor and lurther eBrees to remove seme upon noNce <br /> - ' / � from Ihe City and to replace public property dame0e0 ihereby. T <br /> . ��i�� � � _ . / �..�.� . �� �'_ � <br /> ED F R CONSTRUCTION DAT ACKNOWLEDGEMENT OF CONDI710N5 U� " <br /> . ,{� <br /> ^ APPROVED AS CONSTR ED D � � >�SIGNAT�OF APP CANT�� � DATE �� � <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION a� <br /> POST ON 259•8811 <br /> � EXPIRATION JOBSITE 24 HRS. BEFORE CONSTRUCTION _ i <br />