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everett APPLICATION FOR PUBLIC WORKS P�RMII� <br />� TYne or Urinl clearly wilh ink <br />PRESS HARD � YOU ARE MAKING COPIES �.2 <br />PUBLIC WORY:S PERMIT NO. ___ 3� I <br />EVERETT, WASFIINGTON ����� BLDG. DEPT. NO._ <br />"JC�OWNER ❑ AGENT DATE �/ <br />APPLICANT/FIRM REPRESENTED %�%`CC LS . !lF'.'�� j/✓.Cr _.__ . .._ .__ __ _ <br />ADDRESS d�' .J!E ���m��- ��(L_� -_—CITY ��!F��=� TELEPHONE �5.� �IS��( Z <br />HEREBY APPLIES FOR PERMISSION TO ��SL�L �f ��(d� �Dit,Z'K-�r.,�/PCUCZt�A-`� <br />/ 0 i �/ 1� �t►, <br />ATTHE FOLLOWING LOCATION _LQ� �� �'�'WN^ � __ =""'- -I - �Dr. �'V <br />— ---� ST�.�S_'7 1 � '� _ <br />Attach five (5) copies of preliminary plans tor proposed work. 6raw to scale and show the following as applicable: <br />` Pro�:erty lines and street identity. <br />* Uutline 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 fills <br />othi�r lhan nurmal (oundation. <br />' site drainage systems when req:iired. <br />Erosi n control me,thod; when required. <br />I Nl •�+�, � i�l�l'�'i <br />4 n <br />I. „�•i2P��' ��'1� ('R.S�vr�Pw� crGc� 11 no'� �-o be C�tct�!"tY, <br />��� G�. 1 00 ��-:vP c�ra.,.i�J� .�iu.�t �e cc.��roI1�J u�� ��-�.a I.,�-. <br />3� �-.. c�n.....c+•�e v� brt���aJe_ �v P..bi:c i2�w or�...�.,;..J c��a� `t-o <br />7 Co•��{-naci-�%.n.� ;.rt.�91- lo� �ePse.rr.R b� b�.�'Icier' <br />. `/ ��n� -F-rn.a�crSJ i...i.. 1`�...b��a. 12./w -�n+•— ��41+.�r con•��i-r.�ci-•u:�. <br />._... 7.tt �; ria 6Z C�ta.�r•�l w�/� c�a.�� . . I... <br />� �Nf�P/ El��'a,��e \%K'vG 7ox 1+n�t7� �i aa\Jw�i-ey � ._: <br />��KtiI ( O'f �- �Yt�.if_ <br />� Un,� l�.�s�c �'rt vsa�.s -% C-c �w,,�.�.� :�„�.r� . i� � � �� <br />� s�� haa.�ss`�. �e C�-�C .` I�� � 8 3 <br />a_ :_, i ;., � ,., , . � _. , <br />.,' : : _. . : __ ._..... __ . _ _ <br />� <br />% <br />�_ '�� ��53 <br />E DATE <br />PER�dIT IS VALIQ FOR 1 YEAR <br />EXPIRAT!�N <br />L . <br />_I �._ <br />._.i...._... . <br />I <br />, _. ,. , _!. i .._ ._.'. <br />:� <br />.ir�{ • -� <br />The undersignetl owner hereby agrees to hc:tl and save harml�ss <br />the City of Everetl Irom any ana au ciaims lor damages, costs, <br />expensee, or causes ot aclion lhal may arise b6:ause ol inslallalion <br />antl mainlenance of ihe improvement or other right-ol�way use <br />here�o applied for and lurther agrees to remove same upon nolice <br />Irom Ihe City and to replace public propetly damaged thereCy. <br />CONDITIONS <br />CAL'L FJR INSPECTION <br />POS� O 259-8811 <br />JOBSITE 24HF'tS.P,cFaRECONSTRUCTION <br />� <br />