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0 <br />�evereh qppLICATION �OR PUBLIC Vu'QRKS PERMIT <br />TYPe or print clearly with ink <br />PRESS HAFD - YOU ARE MAKING COPIES � 3 � I <br />PUBLIC WORKS PERMIT NO. __.____ _____ <br />EVERETT, WASHINGTON BLDG. DEPT. NO.�-3I/ I %� <br />`p"],OWNER ❑ AGENT DA'fE ��--�'� � � � <br />.. __-�------� -- � <br />APPLICANT/FIRM REPREEiEMTED _.���« �S /�J'fi _ � _1��/(_- <br />_ - _ . --- -- ----- <br />ADDRESS ���' S, �_��J(=k'ETi /�JA« (�/,q� CITY �=��c.,C�� ��S ��%%1 <br />- � TELEPHONE �. <br />HEREBY APPLIES FOR PERMISSION TO �� �%/iGL �_ � C-U/GY � ZyU��E-7�; �,PiU� u49 / <br />AT THE =GILOWING L.00ATION �_'/ _ "�� ��r�/j�-��JG �%�%r� - 7� � � � +��r, Wtl <br />Attach five (5) copies of prelirninary plans for proposed work. Draw to scale and show the following as applicable: <br />* Property lines and eireet identity. <br />' Outline and dimensions of existing and <br />proposed structures. <br />* Existing and proposed utilities. <br />* Centerline of abutting right of way. <br />CONDITIONS: <br />_...., /. <br />s. Z. <br />3, <br />' Topographic changes requiring cuts and filis <br />other than normal foundation. <br />* On-site drainage systems when required. <br />' Erosion cortrol met�dds when required. <br />iNorth a roy�r <br />� L��/ � � <br />G1 / C ' l u'/ <br />LIC WORKS PER <br />„�Pr., • /.�e•if �� C4SP inPw / �•,-n+� ir �_f -�, 6<� e�ra.; �l <br />✓RI(7 /' •.�y� .'/"�f/nt.J c MH1 / �t GCI.r � ��i.X^t�n M�+ �oT <br />J�,%��."J% v�n��> Sc��..i.e r:<aAiC ber 7'r� �.� �� ��� / i n��� <br />PERMlT IS <br />�XPIRATION <br />, , <br />..,. . _, . . _._ . .. ;._,_. <br />.. ,:.. �.. r '-. .. <br />� i . i � i !.... , � � _.. � ;- f , ' i <br />, <br />� i �! r � � t' <br />1 �' ; t ._ <br />{ i_�. J.._ d _. <' ;.., <br />� i._, � � ' r <br />. .. . <br />� ,. <br />} , _. {.. <br />..2- 3 -dr <br />YEAl� <br />The undersignetl owner hereby agrees lo hold ano save :iarmless <br />the City ol Everetl Irom any ano 3n claims �or d�meges, costs, <br />expenses, or causes ol action Ihat may arise hecause oi �nstallation <br />antl maintenance ol Ihe unprov�^�gn( or other righl-of�way use <br />here�o appliotl lor and lurther �grecs �o remove same upon notice <br />Irom the Cily antl lo r^place public proporty darnaged Ihereby. <br />OF CONDITIONS <br />� <br />POST ON CALL FOR IPi�PECTION <br />259-8811 <br />JOBSITE 24HRS.BEFORECCNSTFtUCTIOM1f <br />� <br />