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i <br /> C:IFarlr�� � �-�- „��6 , �., ., �� l �� <br /> � <br />� everett APPLICATION FOR P BLIC WORK�PERMIT <br /> � TYPe or print clearly with ink <br /> PRESS HARD•YOU ARE MAKING COPIES pERMIT NO. �,` <br /> PUBLIC WORKS <br /> EVE�RETT,WASHINGTON /'� � " BLDG. DEPT. NO. <br /> (��OWNER O AGENT DATE ��"��.�-i-=-a�'� <br /> APPUCANT/FIRM REPRESENTED _____. ---- 5 - 3' �-� <br /> � D 5C� � �^ �i": �e CITY � r�u TELEPHONE `-�v�-C %O� h� <br /> ADDRESS � <br /> `� <br /> r �. � r O .( �lc � � <br /> HEREBY APPLIES FOR PERMISSION TO � P� r � "� `�" � l �' f' � <br /> a � r J <br /> i, <br /> {�C�� /. 1. .�l^�i � Srci. �/E � / F- •� -[ /f'Si , <br /> �OJ)'I f� L�'� N<7G J <br /> i' . '�f '1 ! � �iC l� ' �,� (,1C.^C / � <br /> ATTHE FOLLOWING LOCATION �SL�Y V � � <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale a��d show the following as applicable: <br /> • Property lines and street identity. 'Topoc�raphic changes requiring cuts .and fills <br /> • Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. ' Un-site drainage systems when requiiad. <br /> * Existing and proposed utilities. • Erosion control methods when required. <br /> " Centerline of abutting right of way. ' North ayrow � � /� <br /> o i . �l L� <br /> SiBneWreoFA PI ant <br /> coNoiTioNs: PUBLIC W1O/R' KS 1PEF� IT�1 <br /> . . __. . ._.. . . . . �eQ r�✓1� �'f . (.yr,.�✓J�✓1 `�_ . . . .. j <br /> T_ s� <br /> , <br /> / / �r�r�/H { i7 ' <br /> ;� ..�: /. /I�o n/f �•..�,o;, 0 1' 6Cr�s� � / � �JY., I c�;�+ <br /> � �_._ d <br /> � i _ cr//0 r.ar� D/',o. ,�:� ��p�,o va•_ J A7,� , <br /> , / j! � <br /> � � �., �pE•'-•�+�,d-s � � <br /> f ` _ 2. �Av�s�r�c�io:� 9 �" �i-o A//�nsr O�tSe , /s <br /> � I I � /^/ /(/(/nI 1 r <br /> .. � { 1 . � � C S V �/'��C�( W� / `��/!/ ✓� ��� l-/� � . <br /> . , � �_�- � . . �`� � . <br /> t ' ..._� . ,p/ � � �'�C,/ro SFt'd// n_/ , ', <br /> � i_ 1 . : A� c' ic<.'� -rr'�'��CS' � ; <br /> . ir � �t �j�/' /�v ///; � /, � A _ '. ; <br /> . { y... 1 . � D� �V7"�ir �tJ�i/ U�L ✓7 ��Ut/17Gr �[�'t V�-� <br /> � ' / /' �,p ,� �,�,.��- <br /> ` � ._;:,. .-� . s�Js������ � � �'/,c �a.- s �Py <br /> t. i ... t �L � . . <br /> ' 1 �b ��m�.,�- �ov�-'��/ Gvi�,aC�c �toS�o �7 <br /> � � <br /> � 1 � - �-/� � T�e undersignetl owner herety agrees lo �old enC save hermleus <br /> � � T � � � /��� "'�/ 9��r` the Cily of Everelt trom eny ena au clalms lor damape0. coat& <br /> ' V <br /> � i ;; . axpenses,or causes of action that may arise beceuee ot Inetellatlon <br /> � � � /l�� end maintenance of the improvement or other ri9hbo4wey use <br /> � � �-� � hereto applied for and furthar egrees ro remove same upon notice <br /> � � from the City and to replace public properly demeped 1�ereDy. <br /> � �/`��� <br /> pROVED�OR CON DATE ACKNOWLFDGEMENT Of COND TIONS <br /> . /^ L7 (//', ,,� /; � 7 <br /> �� � �p�Y77/ / /-U"Ll�pJ , i, d:. J P ��) �/ �y <br /> G' •' - <br /> �F V^DASCONST��.JCTeD DATE SI A1JRE FA PLICANT D E ' <br /> PERn!Il,' IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> � JOBSITE I 24HRS. BEFORECOh'STRUCTION <br /> i EXPIiRATIi;=: - <br />