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"'"°" pppLICATION FOR PUBLIC WORKS PERMIT <br />� � Type or pdnt claadY wil� Ink <br />PRESS HARD -YOU ARE MAKING COPIES pERMIT NO. — <br />PUBLIC WORKS <br />HINGTON <br />BLDG. DEPT. NO. �� � <br />EVERETT, WAS (�'_ I `8 � � I <br />�1 OIVNER ❑ AGENT DATE <br />ApPLICANT/FIRM REPRESENTED ��2y � C � � �S� C' ���� <br />,.� ,i�,�^2_ � d �iTM�YC-.RETt TELEPHONE 7� ���3— <br />ADDRESS = <br />HEREBY APPLIES FOR PERMISSION TO �v ` I� � a1 � x�� �' A� A 6� <br />ATTfiEFOLLOWINGLOCATION '' ��'^�n... d S� <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following as app�icable: <br />' Property lines and street identity. <br />• Outline and dimensions of existing and <br />proposed Structures. <br />* Existing and proposed utilities. <br />t Centerline of abutting right of way. <br />� <br />` Tapographic changes requiring cuts and fills <br />other than normal foundation. <br />" On-site drainage systems when �equired. <br />• rosion control methods when required. <br />orth arrow <br />� � � <br />:ONDITI,QNS� - - ---- ----- — _ _ _ <br />. . . : . . . � ' r^: : "-- : . . . . � <br />— � - ` _� . . �oN �� <br />�`�y� V. . , <br />, ..� '' ..Q"�..._..�✓L . <br />V I [ <br />—. —' . .__ �%/J.e �a� �a``O� . <br />� <br />__. .. � _ � . --. . - • ' •��, . . . . . . . . � : ' . . . _ . . <br />._.__ . . . . . . . : . . � � . . . . . . . : . . . . <br />/. . .� . . . . . . . . . � ...� . . . . . <br />.. �_ - ' t _ i .._ ._. .. . . . . . . <br />` D� . � . .�-�,(j� L �� � <br />�iv I <br />, __..._ . Foe�.p - ' - ' _ . . _, � ,�/ <br />I <br />��CI •�S� <br />:� _.e. �69�'k � /--- - a �.. <br />� . (e.�n,.�. � - �� . �l�h M I�(✓J 1�f�� . <br />I� • �/ �/ � I �� ai. � fi° � G � <br />� . .�. , . ��5. .dp� �9(V,. S � •I� ..>°f./ . <br />j. b�; �``� b�p�'° a 7i� f� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The unCersl9�e0 owner hereby egrees to �old and seva harmless <br />the Cily oi Everelt Irom eny ana eu cieims lor dame0e0. coat4 <br />expenses, or ceuses ol acllon ihet mey eri6e becauae of Ine�allalion <br />and mainlenance ol lhe ImOrovemenl or ot�er riph4ol•way use <br />hereto epplied lor end luriher eqreea ta remove a0me uD�� �o11Ce <br />irom Ihe Cily anA to reD�ece publlc proGerty deme9ed therehy. <br />APPROVED FOR CONSTRUCTION DATF. <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPI RATION — <br />SIGNATUREOFAPPLICANT DATE <br />CkLL FV1i �Iv�rca.��v�. <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />