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e°°:•e" ' APPLICATION FOR PUBLIC WORKS PEHMIT <br />.� TYPe or Print cleadY with ink <br />PRESSHARD-YOUARENAKINGCOPIES pERMITNO. $�" z'+ <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. NO. <br />❑ OWNER �AGENT DATE�? �1\�v )_�' <br />APPLICANT/FIRM REPRESENTED kiU�]—_L�IA��_ _ CQ[JS_l �___ _._____ <br />ADDRESS �> >r'� —J—f ���=U`� CITY E_�L�S_S__TELEPFiONE-��3`(�Z�Z <br />J <br />HEREBY APPLIES FOR PERMISSION TO __��i_i.S�i_��--� Q UC' ul �4��__ <br />------- —' _ ------- <br />lCy�__3Z h ��-_ _ <br />ATTHE FOLLOWING LOCATION x����-�� T� <br />-•—,--�, _ J �---------- <br />Attach tive (5) copies of preliminary plans for proposed work. Draw to scale and show the follo.ving as applicable: <br />' * Property lines ano street identiry. <br />* Outline and dimensions of existing and <br />proposed structures. <br />" Existing and proposed uiitities. <br />* Centeriine of abutting right of way. <br />CONDITIONS: <br />' Topographic changes requiring cuts and filis <br />other than normal toundation. <br />` On-site drainage systems when req�ired. <br />� Erosion control methods when required�, <br />* North arrQw, � �� , . ; / 1 <br />\ i <br />LIC WORKS�PERMIT <br />���L.�1`.�C.� .Ln�S�.lil.�� iCf�l��� G2(l"'c� C.1'� '���^.���.� <br />� . . . . . . � v� . C�.,9�(JVP<'� �� A ✓1 ��� Pd1�� I - Z�"i' S Z.. <br />j. . . . . . . . O <br />' 1 . .. � :. . .. . . . . . . � d �.� .l e .�,.� a � w , ci -�-�, <br />� . . . . . . . �C'Ul�e <br />r <br />� I�; - .. .. �vi S� n l 1 � c� �.. � s c�1� t�` P� <br />�._. - `. . . . . . .. . . <br />1 <br />... : . . . . . . . . . . . . . . . <br />j-,-___ ..�._ _... �. . . . .. . _. . . . _ <br />. . � . . . . . . . . . . . . . . . . � . . <br />i.. . . . . . . . . . . . . . . . . . . . <br />� . . . . . . . . . . . . . . . , . . . <br />F_._--_-.....-....:..__.. ... - .. _ .,.. . . _ _ . _ <br />i... . . . . . . . . . . . . . . . . . . . . . <br />i <br />< <br />� l�'- � L <br />0 7 5�n �..., v� <br />S In � .... .-� . . <br />The undersigned owner hereby a9ree5 lo hold antl save harmless <br />the City oi Everetl Imm any ana au ciaims lor damages, cos�s, <br />expenses, or causes ol aclion Ihal may ariso bewuse ol installation <br />and maintenance of the impmvemont or other righ4oFway use <br />hereto applied for and lurlher agrees to remnve same upon notice <br />Irom the City and to replace puhlic p�opehy damagotl ihereby. <br />DATE ACKNOWLEDGEMENT OF CONDITIONS <br />�� , . <br />, . <br />*� , (. � <br />_� � � �,;� ' i. ��: -n-�. <br />,��.2�ii"_ ..���r�,� � V - <br />DATE SIGNpTUREOFAPPLICANT DATE <br />PERMIT IS VALID FOR 1 1PEAR <br />EXPI RATiOiV ���`� - B 3 <br />CALL FOR INSPECTION <br />POST ON 25g.gg11 <br />JOBSITE 24HRS.BEFOR�CONST9UCTION <br />