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� <br /> -, <br /> . � <br /> ---- <br /> , <br /> eQ� APPLICA3'ION FOR PUB�IC VI/ORKS PERMIT <br /> TYpe ur print cleady with ink <br /> PRESS HARD -YOU ARE MAKING COPIES gaC. �y Z_ <br /> PUBLIC WORKS PERMIT NO. <br /> EVERETT,WASHINGTON / J7 � BLDG. DEPT. NO.FI�� d� — I <br /> � �OINNER ❑ AGENT DATE p ��°L <br /> APPLICANT/FIRM REPRESENTED �� - ��/� �lC/ <br /> ADDRESS �� S�C- �'1�C71d'T/ ,�A� L(/iI� CiTY ����'� TELEPHONE � 5!� l L <br /> HEREBY APPLIES FOR PERMISSION TO �'�ST�� �S� �/U� IOi�X/LC;T� ��!!/C�✓�'/ � <br /> ATTHE FOLLOWING LOCATION �_'� v.e(.�('u�- CS��PS ' 7��D) �� }-�Ue- l�lJ + I <br /> Attach five(5) copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: y <br />� • Pro,�erty lines and street identity. ` Topographic changes requiring c�ts and fills <br /> * Outline and dimensions of existing and other than normal foundation. <br />� proposed structures. ` On-site drainage systems when required. <br /> * Existing and propcsed utilities. * E ' n control m hods when required. <br /> ' Centerli�ie of abutting right of way. orth rr / <br /> � � <br /> Sign ureolApplicant <br /> PUBUC WORK PERMI I <br />� GONDITIONS; _ _ . . _ . <br /> I . ,/� ` L <br /> i . / Cj re H� -�c�/7� i� et�S P�" rGh •� �i'r Pct i s !'i v 7 : <br /> . . . � . . r-fU . � C' C�f2fP�/, <br /> �` ; : . �7 /� / <br /> l�_. . : . :a... Koo� f--,��U� ' p��ni�,a�� /�rr5f- �i�� �n .7?z�����c�.a . <br /> ` , . . `7'ri-e ��'T; <br /> I--- . . . <br /> � . ' -3.: :�.+ : a�P.�,� a5 r /�v� �/�eu��� e � i/Y« 6/;� .P. C!. �/ : <br /> . f{ �oCcLt.�.,�.,� /,�/>o j�/ .on5'�rsrcl�io �l s7'!lasr�- bc? <br /> I �_ _ ..�N`�'�,�. . . . . .��Ai�'P�� 6y. bir��c�r, . <br /> t . t`�,�''� � �� � / ,� � G�.� � � _w/ . � � <br /> F _.�y° `\4. . .�, � . . . �//7S . l"/!�C r�/H �D p �/c U. i.. /S <br /> �yt` } :i`�;J4t� C.ONST/'Kt�'�o)� Si�P /S � �� Gellrl P�Lc-y� <br /> / i <br /> /yr � N_ _ . . l!'C!� l. . � <br />� \ ���/ 1���/yt�, . �. . . .� . . � The undersigne:i owner heroby agrees lo �old antl save harmless <br />� � ,.1[f ' Y ;,� , . . . . thn Cily ol Everelt trom any ana au cie�ms lor tlemaBes, costs, <br /> r V ��r,/ .y�,'� . • � � � � � � expenses,or causos of actlon thel may etlse becausa af Inslallation <br />, �--,�!�•:•r� �� - • - � � � - � � � � � � - � � � � � � � � and maintenance c' ihe impmvement or other righFol-way use <br /> '�i,( 4/:��-y ' � � • � � � - � � � � - � � � � herelo applied br and further egrees to remove seme upon nolice <br /> 1 �, � ' ' ' ' � � � ' - � ' Irom Ihe City antl Su replece public property damaged thereby. <br /> AP��-- �,�� _ 6 <br /> FOR CON�TRUCTION AT � ACKN WL GEM OF CONDITIONS <br /> L � � , <br />', C(� ����, //l��3 � 7—l� <br />�i APPROVED AS CONST�U TEG DATE SIG ATURE O APP CANT DATE <br />�I PERMIT IS VALID FOR 1 YEAR �POST CIh �pLL FOR INS?ECTION <br /> JOBSITE 259•8811 <br /> j ( EXPIRATION I 24HRS. BEFORECONSTRUCTION � <br /> � <br />