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-r <br /> �"w Ai�PLICAI�ION FOR PUBLIC WORKS PERIVIIT <br /> � Type or print cleerly with ink � <br /> PRESS HARD-YOU ARE MAKING COPIES ,� � y S <br /> PERMIT NO. <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON / BLUG. DE?T. NCI. a �O �/ ' <br /> IS�bWNER ❑ AGENT DATE _�v��3- ��' <br /> � <br /> APPLICANT/FIRM REFRESENTED ] �-�(�m����- _ <br /> ADDRESS �Z�a S.� E✓u''C�TMA"LC. � cirv Fv'EKE7 TELEPHONE�-S"�/Z <br /> HEREBY APPLIES FOR PERMISSION TO �N•S�L ���/,/I/DE C�iV���:/�'�l� <br /> ATTHE FOLLOWING LOCATION (�'I_�S���FN6 �i�-S' 7�07 �p ' �"�- W <br /> Attach five(5)copies oi preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> ` Property lines a��d street identity. 'Topographic changes requiriny cuts and fills <br /> * Outline and dimensions of existing and other than normal foundation. <br /> proposed structuri:s. " On-site drainage systems when required. <br /> * Existing and proposed utilities. ` Erosi control me hods when required. <br /> * Centerline of abutting right of way. * rth ar ow / I <br /> (L <br /> ign ure ol Applicanl I <br /> PUF3�IC W�RK PERMI ' <br /> CONDI,TIONS: _ _ . _ _- . . _ � <br /> ; . �. � <br /> ; I. �ieen � �e�� easer�P.v� ��eo_ is �,�. 1 -�, � e%u�r�Q, <br /> i : � : : � � �pa .: ���00� '-��� . . �l/�lJ,ri��.RS� ,�?,:l.S� dC� �civ.� T/��/,t.Ovn �Wit". /c.T, . .. <br /> i/ <br /> �I :. � . .3' . 1M� . .�1Gl;yr cr�-5�. :o�� d!'�c�.ta•�2_ �ch Yr,Ei�;c �/�. o. l-ti. �fCu,:;.s�� � <br /> / I� ✓�L / i- I a / � <br /> � .. _.._ dN� � T? Gcn3T/'u•�.Y"io�� m�Sf- bt rC'�O`r��t�.v 6� �l,. �cfr'��. . . . . . <br /> , . � � �e6i-i5' '�/l"a�kc�j.,�t� /�wb/�� i?. D. w. �ro.., �f-�,s : <br /> �__ _ . . . . . . " .GO�S�/!c�*i-o�i . . .Si� . _ iS �o br t-�rsrnr.Ya� F�w�/y.• - ....__ ; <br /> I . . ; � . � . i <br /> � . . . , . . . . . . I • . � <br /> � : : � � : ; : � : � : : � . : : . <br /> �, � .��� r ^� �J _�; , � T� �— ��� The undersigned owner hereby agrees to hold and save ��armless <br /> . . . . . . . . . . . . . . . . . . . . Ihe Cily of Everett trom any ana all claims tor dameBe`. �osls, <br /> �, . . . . . . . . . . . . . . . e�penses,or ceu�es ol action th21 may erise treceuse ot InstaJation <br /> . . .. .. . . . . . . . . . . . . . . . . . . . . . and maintenance ol Ihe Impmvement or oth�ir ripht-ot-way use <br /> . . . . . . . . . . . . . . � herelo applied lor and luriher aprees to remove s¢mr, upon notice <br /> fwm the City and to replace p�blic prope�ty damopad thereby. <br /> � 1 PPROVED F R CON�RUCTION �E � AC LED E T OF CONDITIONS ^' <br /> � y � / �. �� �! J � <br /> APPR VED AS CONSTR ED DATE IGNATUfl OF PPLICANT DATE <br /> PERMIT IS VALI FOR 1 YEAR pOST ON CALL FQR INSPECTI�0�1 <br /> 259-8811 <br /> ; EXPIRATION JQBSITE 24HRS. BEFORECONSTRUCTIQ�1� � <br /> , <br /> . <br /> � <br />