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�,�� � l� 1� �� 1y� l� U <br /> everett pppUGATION FOR PUBLIG�VN��KS PERIVIIT � <br /> � TYpe or Print deadY with ink <br /> PRESS HARD -YOU AR.E..MAKING.COBIFS�--�-��""'PERMIT NQ. -�����-� <br /> pUP�.iC wCRKs CITY OF EVCRET i ,.,L'� <br /> E�'�RETT,WASHINGTON �'''��' ��`�'`'" �' BLDu. DEPT. NO�/��!�— <br /> �OWNER ❑ AGEN? DATE T�y-a-�-���� <br /> L . ^ / �j-� ,y � <br /> APPLICANT/FIRM REPRESENT£D JG//.U-�KS— �T-��O—,SU��_�--'T '"�-�-(/-��r� e '/Zf�! <br /> ADDRESS ���/(—���� — CITYT�i✓�1'l.TELEPHONE �y� 07�� D <br /> HEREBY APPLIES FOR PERMISSION TO _Cy'—c�•� _ i �-�'�"'�'"���� <br /> _/n c-��,��n- -�S_c��c�S--���--Ss..oP1��—_���s1�a v 2 <br /> ��/ �� � j� /_ .�..n f/"/�W>/ <br /> AT THE FOL�O�G LOCATION /�W�--����-w-�•--�'�""'t / <br /> i%�'�C� /`a� ��,,� SF <br /> Attach five(5)copies of preliminary plans for propose work. Draw to scale and show the following as applicable: <br /> * Property lines �nd street identity. ' 7opographic chanc�es reouiring cuts and fills <br /> ` Outiine and dimensions of existing and other than normal fowidation. <br /> �roposed structure:s. ' On-site drainage systems when required. <br /> • Existing ar�d proposed utilities. ' Erosion control methods when required. <br /> " Centerline of abutting right of way. ` North arrow <br /> �� � <br /> Signalur of APPlicant <br /> PUBLIC WORKS PERMIT <br /> CONDIiIONS• �_ � <br /> + � ____r_,_ -� � i � , � � <br /> �--* � � ` - -7-=-j- � � � i �; -, T' � -T <br /> _� <br /> - �4 +,/}. I '_ a- � ;- � - � � ' <br /> � r � �r, <br /> 1 - ' 1-� - -� i ��-- I� _:_�. �.._r-:-- ---1-1_- a. - I_ � �--� . ' 1 t] <br /> � �� _��-�-. ._�^ -i--�-� - '_� i_"_ -. ' •� _. . .. . <br /> i I _ t- , � . . i <br /> I . I� . _ _ IL� _Y I �_i i_ ���� . <br /> _ _� �i I� . � . �-y <br /> � ` _ . ^ y , I • � <br /> � � I � � <br /> 1_ ' -� - � I rt -•�"_ I---� � #r-i-L' -� ' '-�-`_ � -r I I �. <br /> -�I I I �' r � -^�, . , � � . � H F <br /> � � _ _ _.; �-�� -�-� '-4-• �-., *- 1Y' . �� � �} `-� - i � '...{ '� " � <br /> ��^ � � -t� i r � � �' �r-1- .-. . -�T�'` ,. 1. -.-� � � I <br /> I;_ � r._ 1.��-I � . _i-._�_ ? .—r {--�_ i'_ _ i i ' � � �. O � I <br /> � � _�r � i ~ � � _;_i-�. -_i _ : _i_:_ y' +-i :-:- _�- _�J, C �. <br /> � _�-; '-+- . ' --- � , . +--r-� r-�-. �-j� �t- i T ,__:�. �a �. <br /> 1 -+-: - �-! , � 7- j- t '�-' ' O <br /> � � i � i � ' , <br /> � � � --�-- -- �-1 � F <br /> i i � � . '--t + �-?--j_ —_�' __ � " -' � . . � - r <br /> 1�- ' ' +_� {1 -r-� } _� _ _ -- - Y-� � � ;- �`' :; <br /> , � <br /> .�i�---J .. _ r-.-li --� r__•-_j� -� � �- . . _' � �. I � ' , � . , � i0 ; <br /> � C <br /> � � ' � The undersigned owner hereby agrees to hold antl save hannless <br /> � t- T-'�" -1 i ' � � � the City ol Eve�ett twm any ana au claims lor damages, costs. <br /> i I L_. , �_ -�_ _�_t +_ -�-.�_ . <br /> T 1 I � � � T_-. expenses,or couses ol aclion thal may arice because o���stelleHon y p <br /> �� I i 1' '� � t � � Y and maintenance ol the improvemenl o� olh�r riBhPobway use '< <br /> � I � � �� � - - -�•- hereto applied for and luriher a9�ees to remove same upon nolice O � <br /> i �1�.� T .-� y • • irom the Cit and to re0lace public pmperty damaged thereby. r� <br /> - _ ' i • _�--. _ _ Y � F <br /> i _.�._�. <br /> � �:; <br /> APP� OR CONS R CTION A ACKNOWLEDGEMENT OF C ND�TIONS r� <br /> / - /� / � t ; <br /> �� `.4'•� __..� 4�� �� l�cL� i <br /> � �f . C: <br /> � � n <br /> �s_ � �- <br /> APPROVE AS CO JS RUCTED ATE SIGNATUFE O PPL CP. ATE � �, <br /> CALL FOR INSPECTION ' �; <br /> PE�iMIT IS V LID FOR 1 YEAR pOST ON 259-8811 '' <br /> JOBSITE 24HRS. BEFORECONSTRUCTI�N =� <br /> EXPIFnA i!UN ' �� <br />� '� <br /> � <br />