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everett APPLIGATiON FOR PU�LIC VVORKS PERMIT <br /> � TYPe or Orint clearly wi!h ink `I <br /> PRESS HARD -YOU ARE MAKING COPIES pERMIT NO. �-��� 7 � <br /> PUBLIC WORKS ��� � �y�/ �' i <br /> EVERETT, N'ASHINGTON [ BLDG. DEPT. NO._c��^L1�d%I ; <br /> �OVti'NER ❑ AGENT DATE _��/Q1/-- ---- J_ ZC _�� � <br /> APPLICANT/FIRM REPRESENTED �tliE/Y U�_��__���l11f��O_�_�3.��U��—� �I � AL, � <br /> ADDRESS —Z����3��J —CITY �=�C__L�TELEPHONE Z- 1 5 ` 7/ �� <br /> HEREBY APPLIES FOR PERMISSION TO _.11'S� C'� l,s � ` �'� � � � C ��� S�� 1 � vl Pv�J <br /> _�'Ll\J_e �U�Q�_ ct �t a-cSn P S/ ��a v� — -- <br /> ATTHE FOLLOWING LOCATION �-3� r1-_5 ; , GUEI<'C�CC7/U �dZ�� <br /> Attach fivP(5)coples of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> • Property lines and street identity. ' �fopograprir.. chang�s rF q�airing cuts and fills <br /> ' Outline and dimensions of existing and other than normal fuundation. <br /> proposed structures. • On-site drainage systems hen required. <br /> * Existing and proposed utilities. ` Erosion control thods hen required. <br /> * Centerline ef abutting right ot way. ' North arrow j <br /> � <br /> // � <br /> _—__. r S���re O'AO���_ � //- <br /> coN�iTioNs: Pl1BLIG WORKS PERMIT <br /> Thu undersignetl owner hereby agrees to hold and save normless <br /> Ihe City of Everetl irom any ena ali claims lor dama0�s, costs, <br /> expenses,or causes ol ac�ion Ihal may ariso becauso ot in:tallalion <br /> entl maintenance ol the impro��ement or other righPob�way use <br /> �;,� herelo aPPlied for and further a9rees �o remove samo uDon notice <br /> Irom ihe City and �o replace pubiic property damaged thereby. <br /> ��� F,� /� �� �f <br /> � OVED-FORCO TRUCTION �AT ACKNOWL DG EN OFCONDITI NS / <br /> qpp�' ; 1L�1���3Z k �,1� � . ' � V <br /> D S NSTR ED AT SIGNATURE .4R LICANT D TE <br /> PERMIT IS VALID R t YEAR CALL FOR INSPECTION <br /> POST OPf 259-8811 <br /> JOBSITE 24 HRS. BtFORE CONSTRUCTION <br /> EXPIRATIOIV " <br /> _ _ � <br /> _ __ ._._ . . _ ___ . <br /> -- � •�-=---- --- -- -- --- - <br />