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a <br /> T <br /> � <br /> ICVl�lt[ ry . �_ � . - . . _ _ . . . . . .. _ � I <br /> APPLICATIOA FOR PUBLIC Wt�pKS .-ERMIT <br /> i � TYPa or pdnt clearly with ink li <br /> PRESS HARD-YOU ARE MAKING COPIES <br /> I PUBLIC WORKS <br /> I <br /> EVERETf,WqSHINGTON PERMIT NO. ' <br /> I ❑ OWNER ❑ AGENT DA7E ���'�/ BLDG. DEPT. NO._____ <br /> I APPLICANT/FIRM REPRESENTED � `'�� <br /> � �� �E2/E2�o.�/ o <br /> ADDRESS �.S�p �' ��j��/� /�/J _ <br /> I ��� CITY .r/. <br /> HEREBYAPPLIES FOR PERMISSION 7C� TELEPNONE '93— �z <br /> �'.inA i� Tc ,q�c;p TJ <br /> �ODO -- �-�o�f- a��.��X,,.��T�7 f <br /> �� � � E'�.e <br /> ATTHEFOLLOWINGLOCATION _ L(��<-T •�,C <br /> LS/A�✓�- T //J.V,� .�ST✓/S-� <br /> s�,� �� <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 Topographic changes requiring cuts and fllls � <br /> proposed structures. other han normal foundation. <br /> • Existing and proposed utilities. * On-site rainage systems when required. <br /> ' Centerline of abutting right of way. ` Erosion ontrol methods w en required. <br /> North row <br /> �� � � � <br /> Signature ol pplicant Y �' <br /> � PUBLIC WOR " P RMIT <br /> 'I ; IONS; . � <br /> ONDIT <br /> __ _. . .__ . . <br /> ; �4 �/l,L : BY CoulJrT7oEcJS oF Tf/E NC�y IrE <br /> � : . 7:6 -79- . . : . �I 1�'�AK,477a�U oA7�D <br /> � z.! :7-�zArric . cvt �� -rv�wcU 1��Ac�� <br /> I ' FIXZ.�'ST �Al1�', 5t�' �� GCJLGE�u <br /> iyi/c., : :y-`j-,5�-� CVCQG[Z�t;,U: :c.uq y. A.UD . TEI� . o <br /> 3I : �,.r C��D ��T�a�JS : 'U �V THE. Du►r� P : 5:1TE : <br /> ARC SUGI-{ TN Ar TFIE . ► Z" c?.'LVEfZT IS IJOj' <br /> � � : : :Sct�i1lGi1JG. : . A: . tJC.�D , : f�i' MAY _ �- -- <br /> I , 6E �CL�. <br /> . . fv('IiJ:GD BY 7`HG : INSPEC7'afZ . �D As :DCT�R, <br /> � � : ; ,�L.9� ; /l�o': :,�i.t)E_ . _ .FKon. : P/GEoN G2�: <br /> ' . . : _. : _ . . . . _ . . - <br /> I �V ' _. - � - <br /> �-- -- -. _. _ _ . . t� � <br /> I i . . . . . . . .�. . . . . <br /> �� � � : : �I��' � . . , The undersiynetl owner herabY agrees tc holtl and aeve hermleea � <br /> I , � Ih� City ol Everett trom any ana an ciaims lor damepe�, c�s�; <br /> '� expenses,or causes ot ecfion that may eriae because ol Inalnlle�lon <br /> . and maintanance of the improvement or other riphtrof-way uae <br /> � � � � � � . hereto applied for and further aprees to remove sama upon notice <br /> I� � from the City entl fo repleCe <br /> � � public property demepod tAereby. <br /> I APPROVED FOq CONSTRL'CTION <br /> DATE CK WtE GEMENTOFCONDIiIONS - <br /> APPROVED AS CONSTRUCTED / _-`-�y"j� > �� <br /> DATE �"—�at UFl OFAPPLICANT �� / ' <br /> PE TMR II S VALID FOR 1 YEAR DAT� <br /> POST ON CALL FOR INSPECTION <br /> � EXPIRATION JOBSITE 259-8811 <br /> - ---- -- 24 HRS. BEFORE CONSTRUCTION � <br />