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-, <br /> � <br /> __ _— <br /> _ _ - --- - - — . <br /> everett APPLICATION FOR P�lBLIC WORKS PERMIT . <br /> Type or prinl clearly wiln ink G � <br /> PRESS HARD•YOU ARE MASCING COFIES pERM1T NO. ��—L�_ <br /> PUBLIC WORKS <br /> �EV RETT,WASFIINGTON / �� BLDG. DEPT. NO. � ��. <br /> WNEF ❑ AGENT DATE `���Z d `_ <br /> APPLICANT/FiRM REPRESENTED���U.S /N�S -/��(� <br /> ADDRESS ��✓U KG�I �IRZL (.v�'y _CITY �� -�TELEPHONE .3S S���G' <br /> HEREBY APPLIES FOR PERMISSION TO ��S%fF�.L- � (.(,�l�C CO��✓LI�C/� �/�/�t`L�f{-`� _ <br /> ATTHE FOLLOWING LOCATION LO% ,�g �'����f�'e _(/S�G7c� � 7a0 �p { "�"� P• 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. * Topographic changes requiring cuts and fills <br /> * Outline and dimensions of existing and other than normal foundation. <br /> proposed strucfures. ' On-site drainage systems when required. <br /> � Existing and propesed utilities. ' ion control thods v.�hen required. ' <br /> ' Centerline of abutting right of way. * No h�row <br /> - Si ature piicant , <br /> PUBLI� WO S PERM T <br /> GONDITIONS: <br /> .. / <br /> : : � . ��Pt'h -B�/��, easeN,,��� a��a. is .J�� -�6 �� c�ea. ?�/ <br /> �'� . , . . � . .d�. . �i O T . _, ..�p�. �f/ Ain�P�� C /�c¢S� 4t GU.? 'l�a��r� o.� <br /> � : ' . : .". : .7L/1e /0 7'�' . . . : <br /> : � � :_. . . �. . 7'�y .c%9rna�fC . o� �rtw�GSe � . Pu6/cc /�. J. l�v. <br /> . . . . . . �accuri-�.,1 ���c � consfiu c�+Q.-� �cuf- .6 e. <br /> - i -- - : : �ePai��O"6l 6.K,����� : <br /> j . . , � �/� / / / <br /> , , : . / ��,6�,J �Tiu�k.<�� ,•r o`u fw.�/i� rl. U. �✓. c�o�.. �,.s <br /> � . . I/ / <br /> , ._. . Go�3�-,^K���--� 5,�t� :� � 6e c�r'u.� �t �a �a;� . <br /> ! . . . � . . / <br /> i . . . . . . . <br /> i����- '—J �t , � � � � � � � � � The undarsigned owner hereby agrees lo hold and save harmless <br /> : ; . . , , , , . ihe Cily o� Everet� imm any antl all cleims for demepes, coxts, <br /> , . , , , . . . . . . . eapenses,or causes ol action ihat may erise hecause ol installelion <br /> , . .. . . . . . . . . . . . . . . - _ . - - and mainlenance ol Ihe impmvxmen� or olher riBhFo4way use <br /> . . . . . . . . . . � � hereto applied lor and fuhher agrees lo remove same upon notice , <br /> ' - - � � � � Irom Ihe Ci�y antl lo replace putlic property demaged ihereby. <br /> �� _. , ,>S �'`z / _ <br /> � APP OVE FOR CONSTRUCTION DAT CKNOW E EME TyF CONDITIONS <br /> �' l/ �3 rr � /lC? �7—Z�Z.� <br /> APPROVED AS CON T UCTED DATE SI ATURt OF PLIChNT DATE : <br /> PERMl1' IS �ALID FOR 1 YEAR �pOST ON CAILL FOR INSPECTION <br /> 259-8811 <br /> I _ EXpIRAT10N JOBSITE 24HRS. BEFORECONSTRUCTION J <br /> 1 <br />