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e"e`e" APPLICATION FOR Pl1BLIC WORKS PERMIT <br /> � TYPe or Print cleady wilh ink . <br /> PRESS HARD -YOU ARE MAKING COPIES `�� � (Q <br /> PERMIT NO. "` <br /> PUBLIC WORKS BLDG. DEPT. NO. ��y U <br /> EVERETT,WASHINGTON p <br /> ' ,�1 OWNER ❑ AGENT UATE _J--.'�-S=�/-- <br /> � l . (�1/�.Gtl�/�( ._— . — ------ <br /> � APPLICANT/FIRM REPRESENTED POl.l1}L_D___-r.__ <br /> ADDRESS ��s22_��/� �-�' CITY G�J<%Z�-TT TELEPHONE Z:S1 — Z�J <br /> HEREBY APPUES FOR PERMISSION TO .—Sf�LaS-T-�Ic�-- '���� '�� -������ <br /> I �!. /c l�t 1 ;SiG /v _._.�YJ�.J��� /-�A 'Q � n �- 00 % /'L-A/ r� L' ' ir`0�'. . <br /> r�c <br /> AT THE FOLLOWING LOCATION `'����-�-----��—' � S�-- _ —. <br /> Attach five(5) copies of preliminary p�ans for proposed work. Draw to�cale and show the fotlowing as applicabie: <br /> * Property lines and street identity. ' Topographic changes requiring cuts anii fills <br /> * Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. ` On-site drainage systems when required. <br /> � Existiny and proposed utilities. ' Erosion control methods when required. <br /> * Centerline of abutting right of way. ' No �a�ro�v'1 <br /> , �:-i_�.�-��T�,l�(� � <br /> � -- - S�9naNre ol Applicant � <br /> ' PUBLIC WORKS P�RMIT � ; <br /> CONDITIONS: <br /> ` . UI � ` - <br /> e l�1 � cl �- � a� m r �_,,. � �-c; n �-��' t�.,��� sT <br /> i. � <br /> oQP�n 1✓� � wa.��S � foo'Jc?C� d'� (`.' . <br /> � � r <br /> �- - �.� ,i � �E-i�f1% D/� C��I�� ' <br /> � � . . . �' ,� <br /> � �_. _ . . . . . . <br /> � : . <br /> j . . <br /> 4- - . .. _ _ <br /> �'_ - . . . <br /> I_: . <br /> i- <br /> , _ . . . . . . � � ' ' � The undersigned owner hereby ^arees to hold and save harm ess <br /> � . ihe Gity ol Everett Irom any and au claims br damages, wsls, <br /> expenses,or causes of aclion that may arise because oi installation �. <br /> � and maintenance ol �he improvemont or other riBh�-obway uso <br /> � �, ' ' � � hereto applied lor and lurlher agrees lo remove same upon �otico <br /> � - , �. - from the City and to reP�ace public propetlY damaged Ihereby. <br /> , .�.-��^'=/""�--�--�' ,• ' <br /> j� ' r ' y/5�/ �`�,� . <br /> � ��•/ '! ' % �-��— ACKNU��DGEMENT OF CONDITIONS �, <br /> APPROVED FOR�CONSTRUCT N D TE � X _ � � � <br /> � ; - ��T��'Z l] ' ' <�;1�-�(� J � - , � -� . . I <br /> � APPROVE AS CON RUCT ATE SI��A�'UAE OF APPLtGANT DATE <br /> ' PERMIT IS VALID FOR 1 YEAR CAL�FO'R INSPECTION �, <br /> POST ON 2��9-8811 <br /> JOBSITE 24NRS. BEFORECONSTRUCT�AN I <br /> EXPIRATION- - . <br /> I <br />