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eV� APPLICAIPI(yl� FOR PUBLIC WORKS P�RMIT <br />Type or print clearly with ink <br />PRC4SS HARD - YOU AftE MAKING COPIES pERMIT NO. g"2�°1_�___ _ <br />PUBLIC WOaKS <br />EVER�TT, WASHINGTON ,7r .7 � z BLDG. DEPT. NO._ <br />�OWNER ❑ AGENT DATE � <br />APPLICANT/FIRA1 REPRESENTEU ���-��S /"'/'CrN�S <br />ADCIRCS i�L�+ S, C. EVc=�'E7T /1'j/fU- U� CITY E✓�E� _ TELEPHONE JSS- Z <br />HEREBY APPLIES FOR PEFMISSION TO IN�f}LC, aS� GI%/!)E �GNCQE%F ��Q/�/EJ�//�-y <br />� - <br />ATTHE FOLLO�NING LOCATION �T a.� C���fi"�E�1E �s��tr� -7ava 1� �r, 4U <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show tlie following as ap�licab;e: <br />* Property lines and street identity. <br />* Outline and dimensions of existing and <br />proposed structures. <br />* Existing and proposed utilities. <br />* Centerline of abutting right of way. <br />' Topographic changes requieing cuts and fills <br />other than normal foundation. <br />* On-site drainage sy`stems when required. <br />* Erosion control m¢thods when reauired. <br />BLIG 1NORKS PERM <br />CONDITIONS: <br />„ <br />�� G�ee.). - a� /f ras.�.�,N.� � <br />i tr��o_ ,s .,� -,% �r c%� ,.�� �. <br />,�: /'' / / '/ � <br />,i . . � I . � . t.Z. . �OOi' �D� CJrqin��C Ma�J�- �f CO•1T/o��f� [�n Y�t % <br />. _ _. ... � . . . . . . . <br />t-�_ 1 __. . �. /b-��/ LYnrN [e�C �a��' �.��G�pt'l'.. ]" //,5/G /l/�/�-ai-s�.t... Ofcu/-���� . . . <br />. J <br />: i. i I. .. c�a[ 7� LL.s.i�"rucTivi+ n�.+5f 5� /`P�Jn,.-n.P b.y pYri�C�/ <br />i �1 J <br />' � � / �,- .� l� ' � � 5/ . { �, � � <br />._. .� �(J�YI R` f�� �i 4 u iC +��%Gi: /i.�. �S CVnS' IwG �C�� . . <br />. � F� . . s.�G _ �s . �r . 6e; c�t�rn�cl ..c�a s�a,� . . <br />i .,t/ , . <br />� <br />' r7 � ' �J, <br />� -� I' <br />;� ��' -= f �' ----, — ; ---- . _-.– . <br />.,,r,, _ . . .� \:,1. . . , <br />'1 <br />1i , i • <br />� � `� . � 1'he undersigned owner herety a9rees to hoid and save harmless <br />i, �. .� �,� the City ol Everett trom any ana an claims �or /�ma8es, costs, <br />I�. ,�! � expenses, or causes of action that may arise because ol installation <br />•, ���` i.� � � � and maintenance ol the improvement or other riBh4obwny uso <br />��, � ' � hereto applied lor antl furlher agrees lo remove ;amo upon noiiCe <br />�.� if Iwn �he Ciry and to replace public property damaged ihereby. <br />, '� � i J <br />�/�� �GrZ' i-� f <br />AP RO��� DATE / ACKY�WL GEME OF Gp�NDITIGNS <br />i" � r / � / � /r <br />APPROy D�ASCONSTR C ED � DATE �' � _SI��EOFA'PPLI NT DATF <br />PERlIPIIT IS �/ALib FOR 1 YEAR �I~ CALL FOR INSPECT{ON <br />�XPIFiATION <br />POS'i ON 25�-8811 <br />JOBSITE 24 HF�S. BEFOFiE CONSTRUCTI4N <br />..� <br />