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� <br /> � <br /> � <br /> , <br /> eVw APPLICA�I�UN FOR PUBLIC V�(ORKS PE�iIVIIT <br /> � TyGe or print clesly with ink <br /> PnESS HARD YOU ARE MAICII`G COPIES p�RM1T NO. �`� 3-3 3 <br /> PUBLIC WORKS � <br /> EVERETT,'�NASHINGTON �����l�� � <br /> �'�WNEF ❑ AGENT UATE L�_�.���L BLDG. DEPT. NO._n_-r� <br /> APPLICANT/F�RM 9EPRESENTED ��C �S ����� -��-�C_ ' <br /> ADDRESS �' �� C=� (_L E ki"� ' �( G���/f�/ CITY ��K�-� TELEPHONE.�S�U44Z <br /> HEREBY A?PLIES FOR PERMISSIUN TO ���L l�- S� ��[" �.Qii;�./,P4•'TE- �IUC'L{/YI` <br /> ATTHE FOLLOWIiVG LOCATION ���C�f�(f�����TfI7ZS "7� �� �� �Z w � <br /> Attach five(5)copies of preliminary plans for proposed work. Draw to scaie and show the following as applicable: � <br /> ' Prope�?y lines ar�d s!ree! identity. � Topographic changes requiring cuts and fills <br /> * Outline and a�mensions of existing and other than normal foundation. <br /> proposed structures. R On-site drainage systems when required. <br /> * Existing and proposed ui�lities. ' Erosion control methods when required. <br /> ` Centerline of abutting right o( way. ' No rrow <br /> _ �i�t ° � <br /> S' nature ol Applicanl � <br /> coN�irioNs: PUBLIC WORKS PERMIT � <br /> I. Cree., - 6c�� �� ease„-.��..1 �+_�r.. �s „o} •-�.> lo� �lea�r� <br /> Z. i\OVF�-�n C�(�A�NR\G 4'.IUS�' b1 OJNTI'�I'PJ� Gv� �{�? Io�. . <br /> � J <br /> i <br /> ..i. �nN RG'w�a5i. u� bcen�aSe -!� t��.bl�c R.'�.w . uccumH� i <br /> � �[7NC �� Cw���-f�.acC�u.� �v���'J� �Jt (ep6:�f�r`J �o� ���� �r_tP/' � <br /> � <br /> � —�- ' <br /> i- I <br /> .�-'briS `�'rack:� �.n-� 1�K����� RJw� •<i'w... •-�tit ooN��-�.act- �a.� •si� . . .. <br /> �� -� �.2". r�ec�tieU � c�ti.�� . <br /> 5. Qc��u�r w2-�e. serwc.z v��v� 6:� � ��«� ��� ��'�n�e, <br /> �. Ma,H����,�.� ewS`-�rr')f 5�i.n�e Cicicss pRcK oj /cr �yb� n jJP� .-naw/µ'T— <br /> L�/f�/JI?Ce' CGN "�I /.i'/�. �/I/C� Ue'1 /C� 'dI/ � � � <br /> J <br /> T'.,e undersignetl oHner �ereby agrees to nolC and save �armless <br /> .1e City ol Everett tmm any ana au claims for dama0es, cosis, <br /> e�penses,or wuses ol aclion thal may ar:+a Seceuse ol inslallatlon <br /> and mairlenance of the impmvement or ether righ4of-way usn <br /> harelo aDPlied lor antl:urther egrees to iemeve same upon notice � <br /> _ I j Irom ihe Ci!y antl to replace p���lic property dame9atl Ihereby. <br /> . G^=r-��� /I`.s�Z <br /> I ROVEDFORCONSTRUCTION �/ ATE CKNGWL �CarMENT FCQNDITIONS <br /> -- �Q t� ,,�e� ! ��183 ' ',± ,� �° z! �L <br /> APPROVFD AS CONST CTED DATE SIG T E'OFAP l.yc.ANT D TE <br /> PERMIT IS VALID FO�i 1 YEAFi pOST �IV CALI. FOR INSPECTION <br /> JUBSR'i'E 259-8811 <br /> I EXPIRATION 24H�iS. BEFORECONSTFrUCTION i <br /> 1 <br /> � <br /> , <br /> _ - - . __ _ . . <br />