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everett APP�.ICATIOfV FOR PUBLIC WORKS PERMIT <br />� TYPe or Print cleadY with mk g� ? <br />PRESS HARD - YOU ARE MAKING GOPIES � <br />PUBLIC \VORKS PERMIT NO. _ `�('�_ <br />EVERETI,'NASHINGTON 3 BLDG. DEPT. NO._��o�`I <br />�OWNER ❑ AGENT DATE ��- __ �o� <br />__ _ - <br />APPLiCANT/FIRM REPRESENTED TJ/�L/S . !/��%J�S_��i(� _ __ ___ <br />ADDRESS $����E__Cl��ZG� /n�tL. W CITY' ��'�� _TELEPHONE �� y`�5 L <br />HEREBY APPLIES FOR PERMISSION TU � ti�ST�G �S � Lti�/D� __(O�1.1',FcT���,�/UEtu+/� <br />ATTHE FOLLOWING LOCATION �0% "�� v�l�'ALC'�V� ��%J9/�S- %�OS 7��"• w. <br />Attach five (5) copies o! preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />* Property lines and street identity. <br />* O�tline and dimensions of existing and <br />proposed structures. <br />* Existing and proposed utilities. <br />` Centerline of abutting right of way. <br />CONDITIONS: <br />" Topographic changes requiring cuts and fiils <br />other than normal foundation. <br />` On-site drainage systems when required. <br />' F�cesreqcontrol mejfiods when required. <br />PUBLIC WOR PER <br />� ^(7rtrn - /-�'/f� CaSr.nr..Y r.t�c /t ncT �o �r [�r4'r�..[/ <br />2, ka� �- �� A ��,.� �s � .��C f�N��R / /� � ���,,:, �� � ;J ,� G � <br />, <br />�� ���/�✓/� o., ,�/r /o � �r.• ;� � � / J,� �fr�„� �,, � <br />/�f � �i <br />3. �-ny Ai,.., rJL oi v.�� /. vS e �4, ���/;� /2 0. �;�. o�n,,.r�,:+� </ ��.. <br />�� 3�n•cr•�-, r,,,sf 6e rr�.9,rrc� 6.� fi,,,i�er J <br />�;/ ,�FLi.'i � �����L i•�r� <br />Ge C�%'Or1R� !{� ��/�1 <br />I <br />S. �f �sr ��2�,-- s��-�;� � <br />P!:?RMIT IS <br />E)� PI! ' 1TION — <br />ICTED. DA E, <br />D FOR 1 YEAR <br />L <br />f�fb�ic.. h�0.(-J.�T.pr•.. rf�/I s.V^c /3 .7c <br />UG7�Vf �X � /" /A<(/ /c� � �1+4 G'. <br />The undersi9netl owner �ere6y a�,�ree!. to hold antl save harmless <br />Ihe Cily ol Everel� trom any ano aii ciaims lor dameges, cosls, <br />expenses, or causes o� action Piat may arise because ol inslallallon <br />and mainlenance of Ihe ��,npi �vemen! or other righ4ol-way use <br />hereto applied for anU lurlher agrees to removo enme upon notice <br />irom the City antl to rep:zce publir pm0erty damaged iheroby. <br />E <br />° CQNUITIONS <br />/ <br />/L- �� <br />POST O,t�l CAL.L FOR INSPEC710N <br />JOBSI'fE 259-881 i <br />24 HRS. BEFORE CONSTRUCTION <br />�' <br />