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r <br />L <br />� <br />L' <br />L <br />eveiett qppLICATION FOR PUBLIC WORKS PERMIT <br />� TYPc or Crint clearly v.ith ink <br />'?RESS HARD - YOU AFE MAKING COPI[S pERMIT NO. ��/3 ��� <br />PUBLiC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. NO _�al���n_I <br />❑ OWNER G AGENT DATE .lv/l l�_L - <br />Di. David Stewart <br />APPLICANT/FIRM REPRESENTED _._ . - - � -- � - - ---- ---- �-- ------- <br />ADDRESS 5028 27th Avenue__West ._CIl"Y Everett_TELEPHONE_2-4.8=9.41i <br />HEREBY APPLIES FOR PERMISSION TO �_^�`"` °�—_'^e _^' .�" o�ase w� �e�a.�t r.X Se fJ1( PS <br />---- -------� 7�—�Q--� --- <br />AT THE FOLLOWING LOCATION ._ _ V_ � �—� -- --- - ----- <br />Attach five (5) copies of preliminary plans for proposed work. Dra�� to scale and show the following as applicable: <br />` Property lines and street idenlity. ' Topographic changes requiring cuts and fills <br />" Outline and dimensions of existing and othe! than normal foundation. <br />proposed structures. ' On-si[e drainage systems when required. <br />' Existing and proposed utilities. ' Erosion control methods when required. <br />' Centerline of abutting right of way. " NoAh arrow <br />�..0..f,t�e-����- <br />$igna�ure of AOP�itant <br />coNoirioNs: PUIBLIC WORKS PERMIT <br />�. FXew.+wTi<n �r •-�o�n..cs��o.. I'! NO .� T� `�'C Q�n�to <br />l�-,�"'.� o.�a.cr.-k t:w,��2 . . . <br />1 1 1 1� <br />7 WP�Ci Sl�f`�.lC �\w< (1 �-p KJC 1Nl�AIIQ 4�00�"ZCu� 1M\M�MMv.�I <br />L• /� \ � <br />PNO� � �P� S\�� G� S\li0 �jl W C� Ca' Y'� �N�\ V`��wW J <br />�.,4�-,,,,,.�ef Scrulc� <br />v —� <br />s�scWe� . ' � <br />/ <br />`���r' ' � a F L <br />A FROVE FO C TR+� ; ION DATE <br />�__ � <br />/,�,��f- .�- �3 _ <br />•� P ROVEU AS CONSTRUC7ED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />T�e untlersigned owner �ereby agrees to hold an0 save �armless <br />�he Cily ol Evereit Irom any ena all tlaim9 lor demege6, Co873. <br />expensos. ar wu^es o� ac�ion �hel may arise beceu68 0� IneIeIIB110n <br />entl nainte�ance ol t�e imOrovement or olher riph4obway uee <br />hareto apDlied br and lutlher agrees to remove seme upon notice <br />Imm t�e Ciry and lo replece public pmpetly dama9� �here6y. <br />P.CKNOWLE�GEMENT OF CONDITIONS <br />�OST Otd <br />JOBSlTE <br />CALL FOR IMSRECTIOid <br />259-8811 <br />24 HRS. BEFORECONSTRUCT�ON <br />� <br />� <br />� <br />� <br />J <br />J <br />i <br />