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r <br />r <br />L <br />t <br />r <br />�""�` APPLICAYION F�OR PUBLIC WORKS PERMIT <br />TYDa or orint clrady wllh ink nT � <br />PRESS HARU •'fOU A'lE MAKING COPIES pERM1T NO. `J-� - I <br />PUBLIC WORKS �� <br />EVERETT, WASHINGTON / BLDG. DEPT. NO.� <br />� OWNfER ❑ AGENT DATE �'�:---'�% _. (.c.- U41 T/tci I���e Sd�l� <br />APPLICf�NT/FIRM REPFtSENTED �' f.a�—L�'-;�-� `, r/ ���-�1-�- =-3 � ' !/, Jc' <br />/ <br />( •�/.��—r CIT;�'�� :���_TELEPHONE �'S i'.. �i� ✓; <br />ADDRESS�-�^ �� , <br />HEREBI' APPLIES FOR PERMISSION TO <br />ATTHE FOLLOWING LOCATION <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the tollov�ing as applicable: <br />' PropertY lines and street identity. <br />• Outline and dimonsions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />A <br />• Topographic changes requiring cuts and fills <br />other than normal fou�dation. <br />' On•site dreinage systerbs when require� <br />' Erosion conudi efhbd hen regu <br />• North�t�' �� � � i / <br />� <br />� <br />CONDITIONS: <br />j......... <br />, . . . . . . <br />li �...��� 1 1 •��. � . :. ; <br />.t I. , <br />�. .. , ... . � .... : ' ._.__..____ .. . , ___ • <br />� _ _ - -._... _ ._�. . _ _.� . ----i . <br />� ... � . <br />I , .«�'_ . j ... � ... ... .:.. . � ; . <br />, .-{_ � � <br />; ' � . ..'. � .' :. . � �. . E i., <br />�._.�_ i . . � ._ � .._ � .. . . : � — . <br />� 1 <br />� • � ^��' � . � i � . �. . . . : . . � . . � . . <br />I.. � ..�.. i . . I � .... .....: ............ ...�-...».t.. <br />, .____.____ +___._,_7 _..��. — — 1�• -• • - . . . . . _ <br />! �::.�.1 1 �:� � :::::_, <br />: <br />� - — '----,-- • ___ ' � ' _. . . <br />I . . . .�� { . . . . _ ! • • ; - . , , The un�ersignetl owner hereby eB�ees to halA and seve �e�mless <br />Iha Cily ol Everett Imm eny ana all clalme lor tlame0e0. co91l, <br />. . . . . . . ' . . . . . , . . . . . . b e ollnatUlelion <br />� �VEO FOR � STRU( <br />��� � <br />A PR VED AS C� NSTRUCI <br />PERMIT IS VA ID <br />L <br />EXPIRATION- <br />1 YEAR <br />. expenees, or ceuses ol acllon ihet mey edse acaue <br />.. . end mBinienence ol t�e �mprovemen� Or o�he� hp���o��M'ey uae <br />h8reio eppliBC lor enC lurl�er eprees Io romOve same upon notlte <br />Irom Ihe City and to replece Oubllc ompe tlemepe0 I�ere6y. <br />�E ACKNOW D IOIE TOF 1'� S <br />� <br />?3 �- i <br />�TE SIGNATU OF PLICANT D� <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 2q HRS. BEFORECONSTRUCTION <br />1 <br />� <br />� <br />J <br />J <br />`i <br />