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i:� <br /> _ � <br /> r <br /> 't <br /> � - - --- - ---- --- ---- - - _ _ -� <br /> r"""` APPLICATION FOR PUBLIC WORKS PERMIT <br /> ; I� Type or pdnt tlearly wdh Ink S•'Z/y � <br /> � PRESS HARD-YOU APE MAKING COPIFS pERM1T NO. � <br /> PUBLIC WORKS <br /> I� EVERETT,WASHINGTON BLDG. DEPT. N0.�G'7G'•3 � <br /> ❑ OWNFR �AGENT DATE��y`�$z <br /> AFPLIc,ANT/FIRM fiEPRESENTED7C.—C�Y�s�`�'��4^��'_tits�s - <br /> 48•z�s <br /> ADDRES� ( � -!L—_�—� w CITY,�`�I u I.c� (�'�`� TELEPHONFlL�1`1 3 `�'�'� <br /> ♦ <br /> HEREB`� ' �ES FOR PERMISSION TO � �2 C�^�-�S�L`'E w�— <br /> AT THE FOLLOWING LOCATION � ��U a j �—, �Y v` ' ��" <br /> Attach five(5)copies of pre'iminary plans for proposed work.Draw to scale and show the fr!lowing as applicable: <br /> ' Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> ' Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed utilities. ' Erosion control methods when required. <br /> 'Centerline of abutting right of way. ' North arrow <br /> ��..�.�,����- <br /> SlgnaNre ot Appl�cent <br /> PUBLIC WORKS PERMIT <br /> GON.DITIONS: _ _ . . <br /> I � � • . . 1 . .� aQ.vva��. TLw.GauPy� `lL Co��nQC�t- rOG�I 'l�fca�n'i <trt<�/Gi" . . . <br /> f ' <br /> � . . . . . . • � . . . . . . <br /> �.. . . .. . . . . . . . . ; . -c��.:f� �?� nvai...�','f" . <br /> � . _� . . - . . �o..IK� <.�'t�•� �f.'1.IN� N�uS� I� P. Scrw . . . . . t/ . . . . . <br /> �'<:prQ. �w�wr,� �L��� � Pv�+OJ r.% �v :��'PIt' x e.K�Cl�ISIUr. ,OI�� . <br /> i . . . . . oC• �k� �)or.��lcr�. .pjt . . V'A�l'. . /DL7-- C7i:lln �iiQ /�'1. W'��C. <br /> T �/ <br /> ! : . . . . ��,��Gl r K�-U �:: .r u i F be r��Jc� !VG �5��, .S�o)- /�u . <br /> � � . � , <br /> � .__-•._ . . _ . . .�l'( "! � ^K ��,,D� 4��0!l�cL'�J�1 ��'V'(^'i . . . . . <br /> f ' . . . . . + �. . . . � . . ' . . . <br /> I � ' � . � .. �...D('.�.�e,v�n. �YC�.IvnctSc'_ .I.S. �19'� - rCl-�. cIC�!�n . a.Cro`.s .Sic��qw'r�'�� . <br /> ..—. . . . . . . . . 1.N's�n.�I :��+.ttl! Jnir\� c'fn ��. ...� C'. lU � .ct.��' . �}�.� ��.nn �o.!f'o . <br /> ----'-._ , . . . (oc�F- . C,Cn �.-.. ./1��� �, . . . . . . . . . . . . . . <br /> —"'-� -- - '--' ' '�� � � � �-� - � � � � The un0ersiqned ownc• hereby agrees to hold ena seve harmlesa <br /> ' ' ' ' ' ' � � ' � � � � � Ihe Ciry ol Everett trom any antl au clalma for damepe0. �osts. <br /> ' ' ' '� � � � i � � � � � � � e�penses,or eauses ol action Ihet mey adee beeauea ol Inelallatian <br /> � � � � � � � � . . . en0 maintenance of the improvement ar other rip�4oi•wey uee <br /> � . � . . . � hcreto epplied lor and furlher agreas to remove same u0o��otice <br /> . . , . . � . � . � Imm tha City and to replace pu611c property demaqed thareby. <br /> �/G <� —�� X � . <br /> L � O FOR NSTRUCTION DATET' � \AC OWLEDGEME T OF CONDITI011S / J <br /> I-I9 -g3 - , f.,.7'�,..� � /c-�- �� <br /> AP ROVED AS CON CTEO DATE SIG TURE OF A ICANT DATE <br /> PERMIT IS VALID FOPI 1 YEAR pOST ON� CAL.L FOR INSPECTION <br /> 259•8811 <br /> L EXPIRATION <br /> ,,2 -� S'- 83 _IOBSITE 24 HRS. BEFOftE CONSTRUC710N <br /> � J <br /> , <br />