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everett APPLICATI�N F�R PUBLOC oM'ORKS PERIV0IT' <br />Type or print claady wilh ink �� <br />PRESS HARD � YOU ARE MAKING COPIES pERMIT NO. �� <br />PUBLIC 1NORKS <br />EVERETT, WASHINGTON 5LDG. DEP'f. NO.� V G `_ <br />�OWNER ❑ AGENT DATE �—� ���G <br />APPLICANT/FIRM REPRESENTED LcLS �C __ _ _ <br />ADDRESS 2�O S,C'� Fvf"�'c� /Y�/ft �- G{�F%y CITY ���-��� � TELEPHONE-3sS���<�� <br />HEREBY Ar'PLIES FOR PERMISSION TO <br />ATTHE FOLLOWING LOCATION _�� �� �/ � C'7.�2L�I 7� �r: G'ti. <br />Attach tive (5) copies of prelimir�ary plans for proposed work. Draw to scale and show the tollowing as applicable: <br />* Property lines and street identity. <br />` Outline and dimensions of existing and <br />proposed structures. <br />* Exis;ing and proposed utilities. <br />* Centerline of abutting right of way. <br />PUE3LflC VIfO <br />° Topographic changes requiring cuts and filis <br />other than normal foundation. <br />" On-site drainage systems when required. <br />• C:rosion control m�thods when required. <br />CONDITIONS: <br />,. /' / / / r <br />: . � . � .� �OU 1 - i��q. Cl/c1..1 Ci { L M�/S� GL �Y)•s Tr:. ��Pc�'� <br />/ ✓ <br />� . . . . . � � . . . , . drl . ffiC' . . �o � . . . . . . <br />� _'-_-. . . . a7. .i'r/l� . CfG. �'�'� u3 c'. . v r_ ..fi 'P4• � 4S.C_. .7�a . /�u E��ic � U, (�v <br />. . . � . . . . � NI/! �i'�, CJ.)�Jr/leG�ic%n •NHS�I- �C ��4i//�.J� � <br />. fJ('C�f/./n+ <br />i��Ii �[1P�% l7 <br />. . . . . .. . -�.. �Cb.^iS ,�rRCKP��/.r f'� ���b�.a. �.O. GU. �ir�n� 'f'�liS c`onsi'��rCT/on <br />'. � . . . �d �-. LS jU E�C. C�PONfcY Y�4 d9/ / . . <br />I' <br />kcs; ��cc vf�p�cD . . �. <br />,1.: _ 6L!/f'�'Fi� SHG�i �(IEEOS 7Z� f'� �L/��UE� ���'�����>I{T T� 6�1�1`E <br />�: <br />; ... ;.. ;...:. <br />._----r,_ ,�__. ___.__._ <br />, . . . . . . . . . . , , . . . . . Th� under..i�ned owner hereby agrees to holtl und save harmless <br />�. .,, j.. .. i. ., .. .;.. the Citv ol Everett trom any antl all claims lor damages, cosis, <br />� - � � • � � • • � � � � � � - � � � expenses, or cnuses ol action t�at may adse 6ecause ol inslallelion <br />� � � � � - - — • - � � � � � � - � � � � and maintenance of the improvement or o�her righ4ol-way use <br />'- �� he�elo applied lo! and !urlher agrees lo remove same upon nolice <br />� j/��9' ��/ �:' Irom �he City antl to replace public proForly damagetl Ihere6y. <br />/ <br />/1i�• _� �/ .GL._ , <br />PERAAlT I� VALID'FOR 1 <br />EXPIRAy IGN — <br />' Q� CONDITI �S <br />l.�- <br />POST ON i CALL FQR INSPECTION <br />JOBSITE 259-8811 <br />� 24HRS.BEFORECO�dSTFiUCTlI�N <br />n <br />a <br />� <br />