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� <br /> � <br /> everett APPLICH: TION FOR PUBLIC WORKS PERMIT <br /> � TVPe or Print clearlY with ink <br /> PRESS HARD-YOU AFiE MAKIhG COPIES � . � � <br /> PUBL!C WORKS PERMIT NO. <br /> r-- <br /> EVERETf,WASHINGTON BLDG. DEPT. NO. � � � <br /> ' �OWNER ❑ AGENT DA1'E <br /> APPLICANT/FIRM REPRESENTED �"-� _ <br /> ADDRESS�.Q/1.��.�1.'��.lL�.�_i�� —CITY L1L���ELEPHONE,.z.z.Z1L�- <br /> HEREBY APPLIES FOR PERMISSION TO �-� `��- �XG�t//V� �R Iv •� W <br /> ATTHE FOLLOWING LOCATION ����� 7�r/ r/�� sC/ C���/� �� K/AtiSi�i �/Pi�-a-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. '� Topograpliic changes requiring cuts and fills <br /> • Outline and dime�sions of axisting and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed utilities. * Erosion control methods when required. <br /> * Centerline of abutting right of way. * N1�otffi prrow <br /> T <br /> �ti i <br /> Ignet re of Applicei <br /> PUBLIC WORKS PtRMIT <br /> con!o�Tior�s: __ . . . ___ _ <br /> _ . _ ._ <br /> � . . . . . . . <br /> : . . . . . . . . . . . . . . . . . . <br /> � . : : , : : � : : � . � : : : : . . : . ; _�. : <br /> , : ; + : : , � : . . , . . <br /> � . � . . . . . . , . . . . . . . . . , <br /> . , <br /> �T �.�r___ �_� . _ . . ___ _ .. . � . ,- --_ __ _ . <br /> � . . � . . , . . i ; , . <br /> f , . . . . , <br /> , _ <br /> , : . : : , . , � . . : : ; . , <br /> .�; .� � . ._._, _ .�. . . _ . _ , . . . . . . , _ , - -_. � . . . . . . . . . , . <br /> I 1 � � , i . . . . <br /> � . : . r . . : l . : � i : . . . . . , . � . j : : . . : . ' : . : j . . . . <br /> . . . . T� . �, . T I . . . � , � . 4 � <br /> � . . . . , . . . . . . ._ ,----_ .�_ � �_� __ T. . . . <br /> (-- "_(— f : � � 1 . . . . <br /> . . . . � . . . t . . i . . . � , . . , . . . . . � . . . . � . . <br /> � . . � . . . i . I . J . . '. . . . . . . . . . . . . , . . . . . . . . . . . . <br /> ..� . � -_ .. . . . .� .. . , ` � r --. . ._ . ... . _ ._ : . . . . . . . . . . . . . . . . . � .. . . . <br /> '-_ � <br /> . . . . . . . . , . . . . , . . . . . { . . . , . _ . , . . . . . . . . . . <br /> �� . . . . . . . . . . . . . ; . . i . . .. � . . . . . . . . , <br /> �_._ __ • _ .. . .. . . _ . . ._ . _ �----+-_�_' . . . . . . . . . <br /> � /// . , . . . . . . . , . , . 'I . . . . . The under3igned owner hereby agraes io hold and sayx hermless <br /> �. /Cf�a��l�.dnypwo : � � � � � � � � � �he City of Eve�ett tro�� eny ana au cieims for damapea coat0. <br /> l . �i o, �r,�.N J lz..��> . I , eapenses,or causes oi actlon iha�mey adse because of inalellat�on <br /> � . . . . . . . . . . . . . . . . . . : . ._ ..__. . . . . . and maintenance ol the imOmvement or ot�er ri0h4oi�way uee . <br /> � � � � � � � � � � � � - � � - � � � � here�o applied for end�uriher agrees ro remeve eame upon notice � <br /> r � � � � � - � � - � � � - � • � � imm �he Cit/ Bnd to repleca public proparty damaQed thereb;. <br /> . . . . . . 7. . . . . . . � <br /> �� - I.7-I�-tiJL <br /> L A R VED FOR C STRUCTION DATE ACKN ' EDGEM T OF C DITIONS <br /> ' z 8 e � ` /� a�/Ss. <br /> AP R ASCO 5 UCTED � CATE TUREOFAPPLI NT DATE . <br /> PERMIT I� V D FQR 1 YEAR pOST ON CALL FOR INSPECTSUN <br /> 259-8811 <br /> EXPIRATION JOBSITE 24HRS. 6EFORECONSTRUCTION � <br /> I._ 1 <br /> . <br /> � : <br />