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—����, s.�v��rTsr. __ .�.�_..�_�. ..;_ . _ � _.: .� . . -._� . .�_._.-_ -. ..—. .__ . .a. <'�r <br /> .. .. . .. _ - � - .�. - =- t a1�;qli��F <br /> _ - - - -- -- - — - - �- :_ .��I41! <br /> 3-� ; <br /> + � <br /> . <br /> ,,.. <br /> everett APPLIC�TION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Print clearly��.ilh ink <br /> PRESS HARD- YOU ARE MAKING COPIES "' <br /> PUBLIC WORKS PERMIT NO. � =Z 'Z 3 � <br /> __ FVERETf, WASHINGTON BLDG. DEPT. NO.�� J�I <br /> ❑ OWNER ❑ AGENT DATE _ 7/29/32_ _ � <br /> r <br /> APPLICANT/FIRMREPRESENTED _EV2Y0tt3dd_dlld PdpOC C0._, Illc.____ __ _______ _ <br /> P�DRESS 21](L36�Sti'02_t.__ ____ _CITY EVOPBtt _7ELEPHONE 259-2133 <br /> HEftEBY APPUES FOR PtRMISSION TO IJO c_h_anqes r0_quir8d t0 eX75t7t1�_StP22t5 Or approaches. <br /> ATTHE FC! LOWING LOGATION �dltl� C�—� '� '��`�__ JI <br /> Attach five(5) copies of preliminary p�ans for proposed work. Draw to scale and show the following as applicable: <br /> � ` Prope�ty line� and street identity. • Topographic changes requiring cuts and filis <br /> ' Outline and dimensions oi existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> * Exisfing and proposed utilities. ` Erosion control methods when required. <br /> " Centerline of abutting rigi�t of way. * No/rth arrow <br /> / ' 1 <br /> .J_-� � <br /> , <br /> _ CL'i.« �t- � ' �`� �� � /r; - <br /> Signature ol Applicanl <br /> coNornoNs: PUBLIC WORlCS PERMIT <br /> . ._ . __9 <br /> , - <br /> . . r <br /> , <br /> Thu undersigned owner hereby agrees to hold antl save harmless <br /> the City of Everetl irom any ana au ciaims lor dameges, costs, I <br /> expenses,or causec ol action!het may arise beceusa ol Instellalion i <br /> antl maintenance ol ihe improvement or other right�ol�wey use <br /> . hereto ap�lied lor and lurther agrees to remcve same uDon notice <br /> � � Irom �he Cily and b replace public propetly demagotl ihereDy. <br /> i�" �� 'r lf''' -.� <br /> � _,�'�-_ � - �-�_ <br /> �_ _ yEa FOF C N�'fKiU��IGN D TE ACKNO,VJLEDGEMENT O CONDITIONS - �, <br /> (\�\ /\�) e / <br /> `J�-X-�^"..•��-c�� _.�_ ���, �' � 'l� ._.-� �S� �l �r��- '.� <br />'i APPROVED AS CO�lS.it�ICTE�� ATE �SIGNA UFiE��FAPPLICANT DAT <br /> PERMlT 15 VALID �OR 1 YEAR pOST ON CALL FOR INSRE�TION <br /> JOBSITE 259�88� 1 <br />' � EX�6RATilUh!— 24HRS. BE�ORECONSTRL�CTION <br /> I <br /> i <br /> i <br /> � <br /> � <br /> � <br />�, _ _ _ � <br />