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\.l <br /> �1 <br />� , <br /> i J <br /> II <br /> I 7 <br /> I .�_T "__'__ _.____. __- _-_._ . ___.__ . .-_.__ ___ ._ .. _ - ___-__ ".___ _� <br /> � <br />� � APPLICA �"ION FOR PUBLIC WOrcKS PERMIT ; � <br />( rype or 0����cleaAy with ink j � <br /> PRESS HARD•YOU ARE MAKING COPIES pERM1T NO. ' <br /> I PUBLIC WORKS ' <br />� EVERETf,WASHINGTON BLDG. DEPT. NO. �,% ����� i --1 <br /> I . ❑ OWNER ❑ AGENT DATE U- 13-Q� <br /> j APPUCANT/FIRM REPRESENTED ���_CL�.�� �- h- �-� -1 ��I S F �I • I <br />� ADDRESS �� �30 7 p//C S. � . CITY �YBv ctl VYqTELEPHONE ,j 53-70� S � <br /> i <br /> I <br /> HEREBY APPUES FOR PERMISSION TO M a i<�. I'�� � t �O N To G �r 3� �,. � <br /> I <br /> i <br />�'` - I <br /> r AT THE FOLLOWING LOCATION /O / 3 O ~I � ��.t_. --{) � . I <br />( Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the following as applicable: � <br /> i <br /> * Property lines and street identity. * Topographic changes requiring cuts and fills i <br /> ' Outline and dimensions of existing and other than normal foundation. I <br /> proposed structures. * On-site drai�age systems when required. I <br />, * Existing and proposed utilities. ' Erosion control methods when required. , <br /> * Centerline of abutting right of way. ' North arrow ' <br />� 1'�r� /,rJa�.�.,� � <br /> Slgnature of ADPlicent � <br />' PUBLIC WORKS PERMIT � � <br />� ', <br /> CONDITIONS; � <br />� i . . . . . . �. - �- , � , � y � . . . . . � <br /> I . . . . . . . . . . . . . . . � .( . . . . . � � <br /> ! . : � . . ; . . Qe�� �,�,Y� a . ; . . � <br /> , � � <br /> , < < <br /> . , . �� . <br />� _._._�___i_. �_ ' _ . _. . .O�� � , . e�i . . , P�J Q •_� -- <br /> I : : ; : . . � : lI� F � �� I /�`' P�%� : : ' <br /> _ �_ _ : . . . . v. �t � I^�, � , A �,v/ r . . <br /> �� / , � . . i <br />, � � : �D�l� : _ . _�.� I .� VJ. s�"' 1 � -� . . � <br /> . . . � . . . �, , , Q-+� �o�' � � �I �� . . , <br /> ; ��: �� � u� : : : <br /> / �,_ I . _ . �. . �\���✓�: . �. , i <br />� : : : : : ' ! : n �'� �p� : � <br /> �� f ,� , .. , ! , `. 1W\� � . . The untlersigned owner �ereby agrees�o �old end seve hermleea I <br />' �I . i . : • 1 . . . . . . � 1 . � . . � � Ihe Ciry ol Everet: trom eny entl ail cialme for damepe4 coats, � <br /> f • • �• { .-,-•-} �� � � � � � � • � � � � � � � � � � expenses,or causes of action thet mey ariae becauee ol in6ullatbn i <br /> � - —•-�•--�� --- •- � � � � � � � � � � � � � � � � � � � � � - and maintenance of the improvement or othar tlflhtrol-way use <br /> � � � • • � � � � � � � � � � � � � � � � hereto aDG��ed br and further agreea to remove same upon notiee , <br /> � � � � � � � � � � � � � � � � � - from the Ciry and to replace puhlic property tlemaqed thereby. � <br /> � <br />, APPROVED FOR CONSTRUCTION DATE ACKNOWLEDGEMENT OF CONDITIONS i „ <br /> APPROVED AS CONSTRUCTED DATE SIGNATURE OF APPLICANT DATE I I <br /> j PERMIT IS VALID FOR 1 YEAR ppST ON CALL �OR INSPECTION ; <br /> 259-8811 I <br /> �_ EXPIRATION _JOBSITE 24 HRS. BEFORE CONSTRUCTION � <br />� <br />� <br /> I ' <br /> I � <br />� -� <br />