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�"""` APPLICATION FOR RUBLIC WORKS PERMIT <br />� Traa o� o�im �tae,ir wnn i�k o� 6 8 f�- <br />PRESS HARD • YOU ARE MAKING COPIES pERM1T NO. �� <br />PUBLIC WORKS <br />'. EVERF.TT, WASHINGTON b• aG -�� BLDG. DEPT. N0. <br />I J�OWNER ❑AGENT DATE � <br />APPLICANT/FIRM REPRESENTED <br />ADDRESS °� 3 � z- � Z 2 n <br />i HEREBY APPLIES FOR PERMISSION TO <br />ATTHE FOLLOWING LOCA'iION �3 �� Z ZZ �� 5�, <br />€uPice �'f" TEI_EPHONE °759—/7 <br />cc�d, /-iona / C`/,vrwo� — <br />Attach five (5) copies of prelimii�ary plans for proposed work Draw to scale and show the following as applicable: <br />� Property lines and street identity. <br />• Outline and dimensions of existing and <br />proposed structures. <br />' Existing and proposedLtilities. <br />• Centerline of abutting right of way. <br />* Topographic changes requiring cuts and tills <br />other than normal foundation. <br />• On-site drainage systems when required. <br />• Erosion control methods when required. <br />` North arrow <br />Signa�ure ol Applicen� <br />iVIVVI,IIVIVJ: . . _ ._.. . ._. .. - _. . _. _ .. . _ . _ � . . . . <br />.,. .: S�er��or o-�: �rP�ti cf�r.��,;...a �,..,�-1� QX�s��,� <br />. . � I . . , . . . �B/. .cinDNVP.aJ ��4'v� V.n �.S f� I i7e IN�a��w`-a I..�r�. . . . . - . <br />_��-�.. . . � ... . . . . . ?.� . . . . . . . . . . . . . . . . . . . . . <br />. , l � . . � . . . . . . . . . . . . . , � . . . . . . . . . . <br />� <br />. ! . . <br />i , <br />. : � � h . . . . . . . . ... - _ _'- . .._ . �. . . .. � . . . . . . <br />,_;_.;—,. _ _,. .- .�_ � - -.. . . _ . _t _. __ . - i + � . . . . . <br />.. . 1 _.�1 . . . ' � . . . � . . . . i_ . k � . . i . . i . 1 . . . <br />. _ .. . . I • I . � _ _.—.� . I . . . � �--- _ «-- . � . - .1 e • •-1�_—' . . . <br />___ ' _ . ' . . . . . . . . . '+'"' . . . . . . . . . . . <br />� ' . . . . • � ' . <br />...... . :�: .��.:�._. f.. ....� .., .; ... <br />-- � : �:! :,_:_a__ . .1 �.� � � �:�_. � : � <br />:::::::i:: ��.;. . ; <br />.... �. �:.�� � <br />.,. :;. <br />____r__-�-.=; -; — ; _ . . . <br />� / <br />/ ��/��/ i/7 -...�fr' O � <br />PERMIT IS VALID <br />EXPIRATION <br />� <br />The untlersiqned owner Merehy agrexs to �oltl and save harmlass <br />Ihe City of EvereU trom any ana e11 tlelms fai dame0e0. �oe�e, <br />exPenses, or causes o� nctlOn Ihel mey eriae hetause ol ins�ellellon <br />antl mainta�ance ot l�e impravement or olher ripht�ol•way use <br />herelo apPlled lor end luriher a0�ees lo remove same upoii nolice <br />Irom 1he Clty ana to replace public property tlamaped I�ereby. <br />OF CONDITIONS <br />1 YEAR CALL FOR INSPECTION <br />POST ON 259-6811 <br />JOBSITE 24HRS.BEFORECt7NSTRUCTION <br />