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� <br />� <br />everett APPLICATION FOR PUBLIC WORKS FERMIT <br />� TYDe or Print Ueady with ink Q ' // <br />PRESS HARD - YOU ARE MAKING COPIES pERMIT NO. `? `�l a S <br />PUBLIC WORKS � <br />EVERETT, WASHINGTON Q I �_�. � BLDG. DEPT. NO. Fr�� ��� <br />❑ OWNER ❑ AGENT DATE _!"l_ �! � ___� '_ <br />APPLICANT/FIRMREPRESENTED _—__.LT-C_f____Cc.�J%-_ __,�s . _ __ ___,_ <br />ADDRESS �,� "� v X!< � � '�� �✓« "I CITY�" �+-�'� TELEPHONE •� � � f `tl, <br />HEREBY APPLIES FOR PERMISS�ON TO �^'� S�✓ti�T �«O `� <br />./ <br />--1.'i � �� �—U'__ <br />AT THE FOLLOWING LOCATION <br />irvl'tV- 7i.ict <br />� ,� o �� v i� C /r ��/:i.. <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />' Property lines and street identity. <br />' Outline and dimensions of existing and <br />proposed structures. <br />" Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />CONDITIONS: <br />' Topographic changes requiring cuts and (ills <br />other than normal foundation. <br />• On-site drainage systems when required. <br />' Erosion control methods when required. <br />` North arrow /J <br />�[�%�Z �_ {i CL fl��i��"� <br />PUBLIC WORKS PEI <br />W 1�� <br />�,r,s��..y /,o�se� <br />� � <br />_---_----r--_ _ _ -, <br />,. .� � <br />%.��d�' <br />�'a'> � 7 <br />�i/'D �Gr'�1+� /N ,�GJ <br />/)�4' j JCI�TL��. �:Cl7C L. '..1 _l_. <br />/i/%�L/ ,"!✓� 1�%��' i I, <br />_ l_ 2a - _ <br />P�,�ri �T" �T 7��� - - - -- - - - - <br />n � � [r �i'��Cr L�V`�° <br />�1 p/> 4R �� � T�e undersigne wner nereby agrees to hold an0 seve harmleas <br />tne City ol Evereu tmm any ano an cleims foi damaqa0. cosls. <br />�� expenses, or ca��ses ol aclion Ihat may arise betausa ol Innlallatlon <br />C .��� end mainlenance ol Ihe Improvemen� or ol�er rip114obwey u!e <br />I heieto applied lo� and lurllier egreea to mmove same upon nOtice <br />, /�, j" � � � Irom Ihe Cily and to replace publlc property demeqetl thereby. <br />� �'� <br />PERMIT IS VALI <br />EXPIRATION <br />1 YEAR <br />2_ <br />ACKNOWLEDGEMENT OF�ONDIlIONS <br />/ ` � ✓� �Z ° ,�LT��/� <br />�� <br />NATURE OF A L ANT DATE <br />CALL FOR INSPECTION <br />POST ON 259•8811 <br />JOBSITE 2q HRS. BEFORE CONSTRUCTION <br />