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everctt APPLICATION FOR PUBLIC WORKS PERMIT <br />e <br />PUBLIC WORKS <br />TON <br />Type or prinl cl3erly wil� ink <br />PRESS HARD - YOU ARE MAKING COPIES pERM1T NO. � G — <br />EVERETT, WASHING �,_ I�_� I BIDG. DEPT. NO. �� � <br />� OWNER ❑ AGENT DATE <br />APPUCANT/FIRM REPRESENTED � A 2 i E C N R i�'i C,rv c E+✓ <br />ADDRESS �-���"2� �d � CITY�YC2�cTi TELEPHONF� � '�3 <br />HEREBY APPLIES FOR PERMISSION TO �� �� � Z� x-3 S" 6 A� A 6� — <br />ATTHEFOLLOWINGLOCATION ���� x'Z � S� <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br />* Property lines and street identi <br />' Outline and dimensions of e' tin d <br />proposed structures. j�� <br />' Existing and proposed i9e' <br />• Centerline of a u' g r�of�. <br />R/ ���� <br />* Topographic changes requiring cuts and filis <br />other than normal foundation. <br />• On-site drainage systems when required. <br />• Erosion control methods when required. <br />orth ar% �) �.�o �0,vx��a.� . <br />�/ I PUBLIC WORKS PERMIT <br />CONDIT JJS, , `b. . __ . <br />� . : .T; . �6 .ADo:,r+v�.�t�- .n.:�v'eu"/�y w� rH v���c <br />n�nc�ur.-p ,y�-. . E,cs�riN� v���'r�nY <br />� . .. ... <br />SL- ALtr)u.�60�. � . . <br />I ;l; . ./•�CCES:i �v«.c� N�4✓� � ccNF i-RoH Exl.:s't/.tJc, -�-, . <br />L_ : _, : . _ ::7i:�:v.�W.�j! /r •�o!Vr.=l4vR�F'TLc�,U �r: : ��i'<"Fi��.iFfT.;ru/cc.: . . . . . . <br />i.::. :Nt i�rc r�: : Ti-�i�-7 � Tc'c cs,>. aR TNc- �ve�d <br />� _ ii'/<L. - !3E . . LtrG�4TEP. /�T LG".95?� . �% � . <br />� . . . . �'Jc�'r�S OF T-�fC �xi7i ;7Jl.�c f%� I.rCWlxy <br />- :N � �..� �f:, ✓c-cvq.y _ . � crti75 rr_�ca i��.i� �[,Qo,� ;� t� <br />; 3;: <br />r.,z , �c�v.�t y <br />��C'oK �c..E/dSr" . <br />�i <br />` . . . . . � . �7?CA� .''h. . .�'� � �.UlJG-/Lc:.�B . ii�Np. /�r{V�,UG <br />1. _: p�- eiis�r,i+E� :«cnu.�N✓� 7�� �c— Pi�i�c-i:TY <br />i <br />= l !�. i�J E�i?h-�i < <br />SiUE�Y? �-iL . <br />F KuM 4=U6C- . <br />,C.i,u� . <br />. . . . '}.�. . MItX. wi17��...Fc. 'D.I . , � . <br />- lhe undersigned ownar hereby agrees to hold antl save harmless <br />� � � � : - ' ' : �;S � '� 7 ' � ; - � Cl ol Everelt Ilom any ana all claims lar damepe& coste, <br />�� . . . . . � � ' � . <br />�C� � . — �.-'; L'/ <br />D R C N TION DATE <br />J <br />Ihe i Y <br />e:penses, or r,auses ol aclion Ihat may ariae Gecause ol inntelialion <br />and maintenance ol the ImOrovement ar other right�ol•way use <br />�ereto appliad for and luriher aB�ees to remove seme u0o� �otice <br />Irom the City and to replece public property AameOed I�ereby. <br />ApPROVED AS CONS' 7UCTED DATE S�� <br />PERMIT IS VALID FOR 1 YEAR pOST ON <br />JOBSITE <br />EXPIRATION— <br />Of CONDITIONS <br />CALL FOR INSPECTION <br />259•8811 <br />24 HRS. BEFQRE CONSTRUCTION <br />