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� <br /> � <br /> everett APP�ICATIQN FOR PUB�IC WURKS PERfiAIT <br /> � TYPe or�rint clearlY with ink �( <br /> PRESS HARD•YOU ARE MAKING COPIES pERMIT NO. V � � <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON � �� BLDG. DEPT. NO. � <br /> ' �OWNER ❑ AGENT DATE "'..�3- L,— <br /> � / / � <br /> APPLICANT/FIRM HE�'RESENTED ���IGU� �YiGS —/�- Ji� <br /> H — �— <br /> ADDRESS .q.v�_�:.�_._���FT �n��- [�L}�(_CITYE✓EI�� TELEPHONE �� Z <br /> HEREBY A�PLIES FOR PERMISSION TO �N S/��' �S� G�t V� /!��VC,Q�-7z__�,�/��,9��_ <br /> ATTHE FOLLOWING LOCATION S�'r �� vC��t�y� ����5 ��D��3�'��� <br /> Attach five(5)copies of preliminary plans for proposed work. Draw to scale and show tlie following as applicable: <br /> ` Property lines and street identity. *Topographic changes requirirtg cuts and !i+ls <br /> * Outline and dimensions of existing and other than normal !cwndatinn. <br /> proposed structures. * On-sits drainage systems when required. <br /> * Existing and proposed utilities. . i�m control n thods when required. <br /> ` Centerline of abutting right of way. ' Nort arrow � <br /> / <br /> - SI nature oi Applicant <br /> PUBLIC WO S PERM T <br /> GONDITIONS; __. , . ..._ . _ _ <br /> � <br /> � . . . � / <br /> �. . . . . . � . � . .�!'PPn,"�'/�;� G'C152 m P.,�" 4�tcc. /T �c� -'7�n �C CJEq�t+ . <br /> ', . �� . , . . � . .��.� . �/OY�.� T�� a�[7/I'! aS C'� m�s �- 6C COn�T�'O��['cL !Y/ 7'+�C ./� . <br /> t... . ...__ . .� 3�� -, /�"•l,�f ClLfrr. t�C�/. � �p� � J.r'�a�e��r�e. �o �'r�6/ec� iP, 0 KJ . . . <br /> 6)GCui'�^�,n V d.rC �e tbna7�i-,..��o.-i lnu5� 6 't . . . . . <br /> . . . ._ . . . . . � � �,�wifN�O� - b.vi�ddr„ . . . . . . . . . . _ . . . . <br /> ' _. . . .� �IPYJ/'/S. .-�/�LC�tcYjn7� . V�/�c �iJ.O. !�v- �!c'^'. y-//�S . . . . <br /> � : . . : . . . . . . . � � CoifSJ�'`aGr.vo . � s,�c �./r �70 �c � cleu.-, c�Y :.,�C, c14.:%�... <br /> � . . . . . . . . . . . . . . . . � <br /> ��..__�-:.__.._ .. .. .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . <br /> � .� . . . . . j . . . , . . . . . . . . . . . . , . . <br /> � . <br /> I-_. __.-•.�,__*-..-_--_—_-_L.�.-._..:--.--.�.,_�--.�_.-._. . . ' <br /> � . . : . . . : . . . : . . The untlemigned owner hereby agrees lo hold and save harmless <br /> �, i : , i �, . , . , . . �he Ci�y ol Everett trom any ana au claims lor damages, costs, <br /> : . , _ , _ .� , , . , . . . . . expensew or ceuses of aclion Ihat mey arise because of InStellation <br /> , _ . .._ . . . _ . . . . . . . . . . . . . . . . and meinlen.nce ol Ihe im�mvnment or oth5r rig,i4o4wey uae <br /> . . . . . . . . . . . . . � . � hereto applled lor and lurther ngrees to remove seme upon nolico <br /> irom ihe City antl to replece p��blic prope�y demeBed ihereby. <br /> c�e�±=_�Z~�F15'i���-.G'�— . <br /> L �aR�o _D FOR CO RUCTION DATE ACKN W DGE NT OF CONDITlONS - <br /> � � ,�l�� _ � � -z�� <br /> APPROVED AS CONSTRUC D DATE S NATURE O PLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL �OR INSPECTIGN <br /> 259-8811 <br /> � _ EXPIRATION JOBSITE 24 HRS. BE:FORE CONSTR�3CTION <br /> a <br />