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� <br /> , <br /> eVw APPLICATION F�f�R PUBLiC WORKS PERMIT <br /> � Type o�print clearty with mk <br /> PRESS HARD-YOU ARE MAKING COPIES pERM1T NO. �_'t a7 I <br /> PUBUC WORKS <br /> EVFR�TT, WASHINGTON � . �� BLDG. DEPT. NO.��/��.5 <br /> �- �OWNER ❑ AGENT DF.fE _ _'�� _'��___ � _ <br /> APPLICANT/FIRM FEPRESENTED �/�_�(:)1 �/i�! -� _ ���(' <br /> ADDRESS �`�•' ��� � � �" ��E ��T/ /)I GL �dYf i _CITY !�6'Ek i i/ TELEPHONEi 1�S << <br /> H_REBY APPUES FOR PERMISSION TO I_'UST��� �� � lV/V t (�CPi��'�(�( ,;1;.,'rd�- jG'!{ � <br /> ATTNEFOLLOWINGLOCl.TION �'� IL ��/�1� �" �Z�"'�� ` 1' _,-�o�C� � � �/, <br /> _!_� F ,i lT� <br /> Attach five(5)copies of preliminary plans for proposed work. Draw to scale and show the foll�wing as applicable: <br /> * Property lines and street identity. ' Topographic changes requiring cuts and fills <br /> ' Outline ar:d dimensiors of existing and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed utilities. ' Erosion control me ods when required. <br /> * Centerline of abutting right of way. ' Nortlarrqw � j <br /> ��-iG� l� C�_. <br /> 7 Signa re ol APPlicanl <br /> co���irioNs: PIJBLIC Wa►RKS PERMIT� <br /> , <br /> I. �o o r� --4,o rJ ci�ct i h a S� raK S I- b e Go,n•�-�1 I�� o� �e ���- <br /> �4 • � �iAvv� uCe o/' bfC'.ctl�aSC � �����Ic. R.G . W , CCLI.: r � .�` <br /> U <br /> c�µ -�--> coKs �'r^w,�-�w'�. w,H.sl- be rG ��rr� h b���lcfer' <br /> 3. �E'-�f'lS �i/!�c rc�G IN'f� PYDIiC R.17, (N. �„'� � �s' ���Q. � <br /> IS <br /> �� �I�a�� �_ .,,P da.�.� <br /> '� /yflJuS'�' (NG�h7 ,SG'r-✓ �i�e da�Yt .rJo1� � yrv�G , j , <br /> �. ,_, T �: <br /> _� . _. ,:_j. <br /> ' _ � , � l � � ;. t :. � � ;: i . ._ . . i ; , r T <br /> , <br /> ; <br /> , , , � , , , . . . , .�� . <br /> � , : " � <br /> , 4 � � E _ ,_ , . <br /> ; �� , � , , <br /> i � 1-' r � , �i � i-; . � _1i ' � <br /> � ' <br /> } ' � t 1 . i_ ' ! 'r <br /> '-_��� ' � � ' � � � ' . ....1.-� 1 � i The untlersigned owner nereby ag�ees to hold an0 save Farmless <br /> }.. , _ . <br /> � � ' � �� � � � � — -I i--- � ihe Ciry ol Everetl irom any ano all claims tor damapes, coats, <br /> '-'1 �""�" ex0ense5,or causes ol action that may arise 6ecause oi installetlon <br /> "�'�-� '�-'��'� and maintenance ol Ihe impr�vement or other righ4ohway uae <br /> O � hereto applied Wr and lurlher agrees to remove same upon notice <br /> Irom Ihe City enC to replacx public proper:y tlameped thereby. <br /> —�B-,�7-�2— <br /> ROVED FOR CONST TION DAT ACKN W DGE T O CONDITIONS - <br /> � �� • � � ,���� �.� <br /> APPROVE�AS CONSTRUC � DATE SIG A URE O APP ICANT DATE <br /> PERMIT IS VALIn FOii 1 YEAR C LL FOR INSPECTI�N <br /> POST 259-3811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECpNSTRUCTION <br /> I - � <br />