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l <br /> � <br /> „� <br /> �everett qppLICATION FOR PUBLIC WORKS PERMIT K�z�a�� x <br /> TYPe o�P�int clearlY with ink J/G�� <br /> PRESS HARD-YOU ARE MAKING COPIES /�t+� <br /> PUBLIC G��ORkS PERMIT NO. r^�'y` <br /> _ EVERETT, WASHINGTON �J 4�j BLDG. DEPT. NO. - <br /> i O OWNER �AGf:NT DATE _!_/�00�___ I <br /> �i�"�a_�_ �t/ViQul/— _��"/lJ�s/_������,�Le�S / <br /> APPLICANT/F`���n�2EPT ENTED u <br /> ADDRESS __ � ��j_��l�_yJ, ITY �/.�PrE�P�TELEPHON�`S�- .�4 � <br /> HEREBY APPLIES FOR PERMISSION TO _4��/�_p ����d � liiG <br /> `�f-� � <br /> ���! 4}( <br /> AT THE FOLL.OWING LOCATION _j� � � r � �M � ` I <br /> i <br /> Attach five(5)copies of preliminary plans for proposed work. Draw to scale and show the tollowing as applicable: , <br /> ' Pruperty lines and street identity. * Topographic changes requiring cuts and filis <br /> * Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. * On-site drainage systems when required. <br /> * Existing and prcposed utilities. * Ero controL ethods w�en req red <br /> ' Centerline of abutting right of way. ` rth a row ��nu%��jp ',�/ �2 <br /> �� �, _�/_.¢ <br /> � _. PP ic7 ant <br /> PUBLIC 1A�%ORKS P RMIT I <br /> CONDITIONS: <br /> � � + ! i <br /> - '� ! -�j� ' 'r - , _ t__ <br /> _ � � i � .i I ' ,' �� , -- i - i <br /> r �Y, I <br /> � <br /> _ � I 1 ~ � � I ! �_r IT _� { ��- i Yy <br /> I <br /> - I L I � ` I r � � ' I I y—j � <br /> �� -�' I I I_ _'_ . , i —1—i <br /> 1 <br /> I I � � I �� <br /> � � -r-�— �j I . ' �. . —i-1� . _�4 .1 � _-F . <br /> " � .�r. 1 � � • <br /> I _.�.ti.� �— rY- �-{— <br /> _ _ __ - I 1 t'_I_ . -1--r_ � I . ._ . , . � � <br /> -�. . I � I ' , � .}� �t-�� ? -- i •-1 I � , 'i <br /> -�__�_f' _– � , - t_ , '-l-' ' <br /> I I <br /> I � i <br /> `i- � <br /> e ' <br /> T'� ' _ - <br /> i - -� t � , L-._ . . , y t. � ., , i . '. � -. <br /> r <br /> 1� - _L. I �-� � i <br /> -1-. t_ _ -1- _ <br /> I i i �-� � , '- ' ,_ <br /> � 1 +i <br /> � � The undersigned owner here�y agreas to hold ard save hermless <br /> � -r�-�- - - - - •-i-rt the City ol Everett trom any ano ali clalms br tlamaBes, cosls, <br /> -� — � i � i -�— expenses,or wuses ol actlon that ma9 atlse because ol installation <br /> � . antl maintenance of Ihe irtpmvement or o:her righl�obway use <br /> � � . h0fe�0 app6Cd IOf antl IurthEf agrees t0 rCmOVt ,ame UROn nO�10E <br /> - Irom the Cily and to replace public property damaged there�y. <br /> ; � Z <br /> AP OVE CONSTR � TION _ T ACKNO LE ENT OF CONDITIONS <br /> V_ / , <br /> i- � � ���� <br /> PPROVED A3 COI VC'YED AT IGNATUR O PPLI DATE <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTION <br /> 259-8811 <br /> � �XPIRATION�� =� .10BSITE ZqHRS. BEFORECiDNSTRUCTION <br /> `...y - .. _ , <br />