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--- <br /> everett ,,qppLICATION FOR PUBLIC WOR�fS PERMIT <br /> Type or print clearly with ink <br /> PRESS HARD-VOU ARE MAKING COPIES pERM1T NO. �a �� <br /> PUBLIC WORKS <br /> EVERETT, WASHINGTON BLDG. DEPT. NO.�� �� U� <br /> ❑ OWNER ❑ AGENT DATE _ �'_�_�—_____ <br /> APPLICANT/FIRM REFRESENTED .�_�_�p.R-GG_-_`�v ��Sti'(Lv�.--_ _ _ <br /> ADDRESS �O�Q—v 2� � 6 � 1<'t� _CITY ��-�� TELEPHONE�71'�- ��aR <br /> HEREBY APPLIES FOR PERMISSION TO �T�V� R � V�� \<6S1 A_G u �-�' <br /> AT THE FOLLOWING LOCHTION SJJ11 Z 3�� � " " �i ST <br /> Atfach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following 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 wFien required. <br /> * Existing and proposed utilities. ' Erosion control methods when required. <br /> * Centerline of abutting right of way. rth arrow <br /> �M,-.o �1' / / A�-�-� <br /> Sigr.aNre of ACPIicaN <br /> CONDITIONS: F�UBLIC WORI P��MIT <br /> . . i - •-, /' /�OO T C�rlJIAS /'YJK.SP' (�< G/�SC�i/r."cJ' /HVu _ .. <br /> t � . : �l� - �..e //s o.�, o�t �oro��.-� <br /> � r <br /> i a. �r+�4o.•��y e/o�.o•; oo K '� / w�// L e �.rsV=r//.�{/ <br /> �. � ' . q S �'p� kI/�� D� �r /- a.S�cC wo�k � ��^ �P�VE7r <br /> I <br /> ...I_fi;._i_�.1__._ � �ro��%T 4'�w.► A.�� �J`p,pPr�i� S� <br /> ! <br /> ! ; -�_ <br /> . <br /> � 1 � � <br /> i " . . <br /> � „ <br /> 1 � _. �� � §. . .._.! i.�_ t .._j_ ._a_.._ ..r .,..� r _ . � j . . . ` .. � _. � I I � <br /> � —'� � , " j � 4 � i i ` ' <br /> . . � ;.�...i � .L, ��.�. , � :,,•-�- � ' . <br /> t _�....: .._..:.. } ...�. - ' ..... ,. <br /> i . ._ ! i . ' ; I . i � '� �; ' The undersigned owner hereby agrees to hold and save hermles5 <br /> � I i , � ' � � . Iho City oi Everetl Irom any ana all claircs for damape4 c^:fs, <br /> .._..L_.;._�',. �.. expenses,or causes ol aclien ihat may arise because of installetion <br /> �� �. ..�� '� end maimenance ol Ihe Improvemen� or ot�er righhof�way uae <br /> hereto applieA for and lurther agrees to remove same uoon notice <br /> � from Ihe Cily and to replace public p.•operty Oameged ihereby. <br /> �� Z �� <br /> OV O E ACKNO EDGEMENT O CQNDITIO <br /> % � J <br /> �� �.o/-r�-'�.� "�-" , - ,� ,v� <br /> OVED C N TRU TED DATE SIGNR URE APPLI DATE <br /> PERMIT IS VALID FOR 1 YEAR w pST QN CALL FOR INSPECTION <br /> 259-8811 <br /> EXPIRATION ��B��T� 24HRS. BEFORECONSTRUCTION <br /> (- <br />