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everett pppLlCA�ION FOR PUBLOC 'iNO1�KS PERMIT <br /> � TYPe or Print cleadv with ink �+ <br /> PRESS HARD-YOU ARE �dAKING COPIES pERM1T NO. r,`� �'� �� <br /> PUBLIC WORKS — <br /> EVERETf,WASHINGTON �_ ���� BLDG. DEPT. NO. <br /> �ON/NER ❑ AGENT DATE J <br /> �/LGIS�7"Y/�� /-�itJC�i - j <br /> APPLICANT/FIRM REPRE5ENTED _ �--------- <br /> ADDRESS g2�S�E�EU(:I��7 M� ��`� CITY �UE�E`/ TELEPHONE SS^��� I' <br /> HEREBY APPLIES FOR PERMISSiON TO L�A�� �S ���E ���1J�2E7C ���vEW�{ � I'I <br /> AT TNE FOLLOWING LOCATION �aT 7 ���E� �7�7�5--`�=s--'���� � ' " � I <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 filis � <br /> * Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. * On-siie drainage systems,when required. � <br /> ' Existing and proposed utilities. ` Erosio ontroi methods .vhen required. <br /> * Centerline of abutting right of way. ' North arr w ,, �/ /y � <br /> tL����-� , <br /> � Si na ure c� App icaN <br /> PUB�LIC WORKS PERMf�' � <br /> ; <br /> CONDITIONS: / /. / <br /> � `.. ��'Cf ". �U 'i . c//e.�n ..'( �. /'+'iu� )�' (i:� LI:o7�ro��f:f O.� ffle' �i^ � <br /> � / <br /> / [ / I / / <br /> � �i IYN < Gi)a �.�' I'.". . 4'_�.:f=t•� c, .—/J ��(. �/C �i�('�J/ �C/ (L�'�y CC'` 1, / �'% � <br /> / Y // 1 ��(( / �/// �J. <br /> G.v.1JT/'lf�..Y./`1.'n MYJf �J� /'Pn�YiIl�-t" /�y Clll//C�✓ <br /> . _ . . .. .� . .�l !l�/? . .'�//1:G.C�r�f' /�t�h. .�u��i� �CiS��T -G it"' !-✓ if ._r,-r�.�. ,�Lf/.i , . . . . . . <br /> �� / , <br /> . . . . , c'U..d:�Y'nccf�i'r� �. S:�+Z /�. �.�"i �ic: t�C'n.yr%��.k/J ���i,�y�. , . <br /> / <br /> , . �. �`� . . . . . . . . . . . . . . . . . . . . . . . . . . _. .. . . <br /> . . . � /� . . . . . . . . . , . <br /> r � ) <br /> , �, %C� �. �%�r_�-/-',�1��� � �. � � � <br /> � � � � � � - � � � � - � The undersy^netl uwner hareby agrees to hold and tave harn:less <br /> � � ihe City ot Everett trom any antl all claims lor damages, costs, <br /> � � expenses,or causa,ol acliun ihat may arise be�aace of installa�ion <br /> t <br /> � ' . and mainlenence al the imOrovemen: or olher rig ho-way us <br /> ' � ' ' � herelo oPPliod lor antl twlher agrees to remove snme upon nolice <br /> � Irom the City nnd to replaCo public property damaged theraby. <br /> ., � � �----. J// . . <br /> .. !�j', '��'�`��I�-.--- i e1/ a�'1 <br /> ROVEUFOR CJ NSTRUCTION DA ACK.NOW�DGkME T F CONDITIOIJS / � <br /> , ,� _ ; / � ����,�- ��� , �� � <br /> ,, c � „ ,��, <br /> � ��r�,-� �!� �� - 3 G� � - <br /> �-- <br /> AP�ROV � CONSTR�dCTED � � DATE �NA7UREOFAPPLIC%�ANT � D TA E <br /> PERMIT IS VALID OR 1 YEAR CALI'_ FOR �NSPECTION <br /> POST ON 2�9-881 'i <br /> JOBSITE 2q HRS. BEFOR�COI��TRUCTION <br /> EXPIRATION <br /> y-- - - - - _ .� � , — <br />