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� <br />� <br /> , '. <br /> everett ��pp���AT101� POR PUB�.I�C WORKS P�RMIT <br /> � TYPe or Prinl cloerlY with Ink ��% � <br /> PRESS HARD-YOU ARE MAKING COPIES pERMIT NO. �� <br /> PUBLICWORKS a2 �/i9�o3I <br /> EVERETT.WASHINGTO� BLDG. DEPI'. NO.� <br /> �OWNER ❑ AGENT DATE _ �� 3 �y <br /> APPLICAN7/FIRM REPRESENiED �1'��•L�`S 't�'C� 1i1.1G <br /> Q�(p •/�DlU,q•./-C�Ty �(�fi�E `� TELEPHONE���� <br /> ADDRESS (� S� f <br /> HEREBY APPLIES FOR PERMISSION lQ ��S��G�" �/ ��`�� �����G �lV�l(/A-�/ <br /> AT THE FOLLOWING LOCATION �T �� ������'✓ �T�T�S+7��a �� A�e ,W <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 identity. *Topo�raphic changes rec;ui!ing cu2s and fills <br /> ' O��tline and dimensions of existing and other than normal foundation. <br /> proposed structures. * Or-si3e drainage sy�tems when required. <br /> * Existing and proposed utilities. • E� control method when required. <br /> ' Centerline of abutting right of way, * orth arr w / <br /> /„ � <br /> �e.i- <br /> – Signature o Applicant <br /> PUBLIC W�RK ` ERMIT <br /> QGtJDITIONS; _ .__ . _ _._- - - -- - -- ---- - - _ <br /> i , , . . . . <br /> f i f f , / <br /> f � / . Cl0 7 /.v� �/�..� <rSL .inus � . G ' -f� � 7�_ <br /> E . C'd.r'�Cc/��. � nn ie e <br /> � . .. . . . � . . . . . ✓. . . . � ,/� � � , , . <br /> � � � <br /> � � ; : . . � . . . . . . / � ,�j �(�. ./f. �i . LtJ . . . ' �. . <br /> �. . . � . �. ..�i,�/. .tfG.'ir�a5.� _ c�c. �.Urrc��:jg. .� . /�u. i � . /� . <br /> � . . .` . . cc-� io., . :n.:sd Lo�- %t'�m{<..�� <br /> p.C.�1.cr �n c�(r� G . i7�' Go.� S.�i� <br /> � _ ._'_ : ;�� :� ' �� : : : . <br /> F„ r� / <br /> .. �.. ��,. : �l'�'�ris .-7rC/ c,�r�! �. �n /". f�� 6/;L . .� O� w. . -/��',-.. ��'h' T . �. . : . . <br /> ...�.. - . ; ' ' . G'IJH.>T/'a!47'ov� . `J�'YC'- , /S. .. ` � . .bti � ' G'�PG1.9 NcQ v�/J .c�n��.. . <br /> T" <br /> . . i : r___ i . : . � . . . . <br /> j _: : �: � � � : : � . : � - : ' <br /> . � <br /> —1—---�-�-- �"'–" � 7he undersignetl owner hereby agrees�o hold and save harm�ess <br /> I . ' . .. .. + . . • ' � � ' I • • � � - � Ihe C�ly ol Evere�� inm any ana all Gaims for damages, costs, <br /> i � i i_ . . . . � . . � I . . . <br /> expenses,or causes ol action ihat�ney atise beceuse of installallon <br /> i � , • • ' ' ' ! . � � ' � � � � . � and maintenance of ihe �mD�a�emanl or other AgnPol�way use <br /> ' '��' " ' ' ' � ` � � herelo applied lor and further agrees�o remove 9eme upon notice <br /> ; " ' ' ; � � � . . . � . . . . � � � � Imm Ihe Cily and to �eplace puDlic proDetly dema9atl thereby. <br /> �/l� �'�`�--� �_ �i yz <br /> ,ACRRQWLEDGEM� NTQFCONDITIONS � <br /> ROV D FO�ONSTRUCTION �� � <br /> ' // �n <br /> � L �l'-- <br /> A D AS COt S UCTE■ DATE <br /> q F LICANT J DATE <br /> PERMIT IS VALID FOR 1 YEAR C�.LL FOR INSPECTION <br /> POST 6N 259-8811 <br /> JOBSJTE 24HRS. BEFORECONSTRUCTION <br /> i EXPIRATION <br />