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i -� — . _ _ <br /> �eve:ett qpp��CATION FOR PUBLIC WORKS PERMIT <br /> TYPe or Print clearly wilh Ink <br /> PRESS HARD-YOU ARE MAKING COPIF:S pERMIT NO. �� ��Y <br /> PUBLIC WORKS <br /> �EVEREI7,WASHINGTON G BLDG. DEPT. NO. � /��7�� <br /> OWNER ❑ AGENT DATE �— '0 L <br /> APPLICANT/FIRM REPRESENTED �GU ' F�S �(� <br /> ADDRESS (��G� Sr �' �(��2C7I_��'/L (�/�`� CITY ' ��� // TELEPHONE�-s , �/7`�z- <br /> H[REBY APPLIES FOR PERMISSION TO 1�S/�ItL- CJ1� � G(J//)F �(J-jr,/�(/1(--%Z' ��/�_�jr- !.[/��'/ <br /> ATTHE FOLLOV�'ING LOCATION `-U� �� �'�F(a-�eis�._ �j/`�y"�" — 7aJS � ' /t'v�- Lv. <br /> Attach five(5)cop?2s 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 arti fills <br /> ' Outline and dimensions of existing and other than normal foundation. <br /> proposed str�ctures. * On-site drainage systems when required. <br /> • Existing and proposed utilities. * Er ' n control methods when required. <br /> * Certerline of abutting right of way. orth rro / <br /> (O�" <br /> Si nalureolApplicant <br /> PUBLIC WOR PERM T <br /> CONDITIONS: _ <br /> j . ��. � <br /> � : % ,�vreP:-, '���� .e�tsP.,�P•.� cri-�a. �s nc � �, 6c> c'fea,-��� <br /> � . . - . . . / . / � <br /> I . . . . . . `Q. �oo � 7`�� �J�'ainr�� � ry.�5f 6C GUn �iv/�r�o.r �ie �0'7; <br /> i . _ . <br /> i . �, . . ,IM . . <�A�n Y�'e. {o;-- �iPa Ic �t� � �o �K6/'� iP O. �v . . . . <br /> , . .� . o['t�t.i�i�n( d`N� �n ��0.�5�.-a a fro,.� �wSJ- ��- <br /> ,� . . , ,� .�� - � . . . . . ./'��C�i'P�. � 6, � btvi/6/t��'. � . . . . . . . . . _ . . <br /> _ _ . . . . / . �CO!"!.5 .�/-d E.P�/n ��+.�a. IPU. Gtl., '�Y"t�.+. ry-�j <br /> ' / �-f' . . <br /> l �_ . . . . . . . Gon 57��u � 7�0�i ; S,�e is ' � he c�EZIn � /r,o c�.ii/y . <br /> � . . . . . . . ; . . <br /> / <br /> . . . . . . . . a . <br /> . . . , . ; : . . . <br /> � - - --�__.__ --:� _ . . <br /> ' � � � ! ? � � � � � � � � � � � • � • � . The undersigned owner hereby a7rees to hold and save harmless <br /> ; ; ' � ; ; : • i • � � � � � � � � � Ihe City ol Evnrell Irom any ana an clsims for damages, cosis, <br /> � � - expenses,or causas ol action I�al may arise hecause ol inslallation <br /> ' ' ' �' '� ' - - � ' � - ' � - ' ' � � � - and maintenance ot ��e improvement or o�her righbo6wey use <br />�� � � � � - � hei3to applied for and furth�r agrees tu remove seme upon nolice <br /> I � � irora the Ciry and lo raplace public property dameged ihereby. <br />' ���� ,_ f�i�,����-�-z <br /> L APP�q V�E�FORCONSTRUCTION 9ATE ACKNO LE GEME TO CONDITIONS <br />�I 1,�(,� ►- r�l � 7- z-- �"L <br />'� APPROVED AS GONS'f� TED DATE SI O A P ICANT DATE <br /> PERMI'' RS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 759-8811 <br /> EXPIR14TION _ J1�BSITE 24HRS. BEFORECONSTRUCTIOFJ I <br />� <br />