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�re" APPLICAT..aN FOR PUBLIC WOR..S PERMIT <br />� TYPe or �rinl clearlY with ink , '. <br />PRESS HARD • YOU ARE MAKING COPIES pERM1T NO. �' ��� �l <br />PUBLIC WORKS <br />EVERETf, WASHINGTON BLDG. DEPT. NO.. <br />❑ OWNER I�AGENT DATE —1� i- � <br />APPLICANi/FIRMFiEPRESENTED %�''��=�'�-��7 � �'�.__ t__�. <br />ADDRESS � �=' ' � � � J CITY � • %i TELEPHOME - � � /' � � <br />HEREBY APPLIES FOR PF.RMlSSION TO —. �^�S� �< < �'� •fF'ta'it? J [{ � <br />�.�.r'i/.1[/ .�-;.)1:.�.7t�t', 1� �Y/.�w�/ _�n/ _.�_i:-( .'-�'.:'�,✓ <br />AT THE FOLLOWING LOCATION <br />'.i,ii . (: ,- �. . .` � <br />Attach five (5) copies of preliminary� plans!or proposed work. Draw to scala and show the following as applicable: <br />' Property lines and street identity. <br />* Outline and dimensions of existing and <br />proposed structures. <br />* Existing and proposed utilities. <br />* Gent?rline of abutting right of way. <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On-site drainage systems when required. <br />' Erosion control methods when required. <br />* North arro�v <br />,, - l i :. �_: �_,�-r�.� - <br />Sipnature ol Applican� <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />�.. <br />� _ �.�I _. . . �-� r r < ,� �.., ��r�.,; .. � : � <br />, � <br />,.. ..�� � .., <br />. . ; , . . b: �-� , •,�� u �.1..� �, <br />� - -- __.. . I <br />. �-1 . _ . •�?5 a`J�JfJJr�)� �'J�..� i'�Ublic <br />:,.. <br />: _.:-.� ._. . . <br />...�..... .. <br />�_ � � . � � i . ._�� �_�__ . . . . . . <br />;.�'� ::. '::. <br />� _. ._ __' �- �- �- -- . � . . . . <br />, � <br />r <br />i ,� , <br />��,�, <br />,� :: �_ : �� �� �Vr.,��, ��.a : <br />�--:�:�: : _�Y,_ . . " : �___:_`! <br />� , <br />' . . . : . . . . . . .�...;. . 13Q . . . <br />. . � . . . . . . . . . . ....-�..._....._.r . . . . <br />, . . . . . . . ' . .�� � . �,-� �..•T1�. . . <br />�� �r=- S s- � z_ <br />�PPROVED FOR CONSTRUC7IUN DATE <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALfD FOR 1 YEAR <br />EXPIRP,TION S S - �L <br />' 1 � I .; I '„ .. : V� -, .�_ z <br />�ti�:��ls �}3 :,..<<� �� � <br />t, v ork 5 �/ � 3/ 'J 2-- <br />The undersignetl owner hereby agrees lo hold and savn harmless <br />Iha Ciry ol Everelt trom any antl an claims br damages, costs, <br />expenses, or causes ol action that may arise because ol installation <br />and maintonance ol Ihe improvr.ment or o�her right�ol�way use <br />here�o applied lor and fur�her aBrees �o remove seme upon notice <br />Irom the Cily antl to replece public pmpeNy demagetl �hereby. <br />ACKN�WLEDGEMENT OF CONDITIONS <br />, ,. <br />SIGNATUREOFAPPLICANT DATE <br />CALL FOR INSPECTIOW <br />PCiST ON � 259.gg� � <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />