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eV,A APPB ICATIO�! FOR PU�3Lt�G WO'RKS P�:RIOAIT <br />�� Type or prin� CleaAy wit�� ink <br />PRESS HARD - YOU AR= MAI<ING COPIES �{ y�% <br />PER!v1IT NO. __ � � <br />PUBLIC WORKS <br />EVERETT, WASHINGTON C� J, �/ 9LDG. DEPT. NO. $a `O l��Z <br />" �OWNER ❑ AGENT DATE . !j /v �3 � <br />APPLICANT/FIRM REPRESENTED (1 �L�-�S_���� ��� <br />ADDRESS D�=S .F�� I�����-����- LV�CITY �V�r�� TELEPHONE3� 7(�z_ <br />HEREBY APPLIES FOR PERMISSION TO l�s'�_ `��, w��� ���«�T� ""' ������� <br />--- -_ - -- --,/---- --�1 -- � -ii, / - <br />ATTHE FOLLOWING LOCATION �! '� W��� ����� ��-�flI I �� :• �Va <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />' Property lines and street identity. <br />* Outiine ar•d dimensions of exi,ting and <br />proposed structures. <br />* Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />CONDITIONS: <br />' 7'opographic changes requiring cuts a�d filis <br />other than normal foundation. <br />• On-site dra;nage systems when required. <br />`_rosi control ma ods when required. <br />North rro <br />--�-� ��� <br />PUE3►LIC WOR14� PERMI <br />4/ , „ �, / , (/ <br />� V��P��.� _/'i2 !1� p>,�Cr�� „�f •-.�'f�" .irC:s. /S Nc � 7-� L�c� CI�C. i �'<_.\ <br />r� / 1 / / !" YX � /p l—' <br />f,.�, �i�%07""� l"--� !�'/�lron�✓C' ��:JS� �C, GG��7"/Y���J .f»: z <br />3. �il,� Cildir�Q t, e�r' 17i�'a�<a� "'�. �o fc�r��%.c. �C1.�/t.�. G�Cr:rr�. r <br />C(L./� � Wi�IS�lI'!..^-7 ror, M415/' � L /C"�Ri/rr� 6., �7<v� /C/��CJ <br />---� / /f }� l / '1/ <br />� � J,f'f�/'�S �ii C/�c� �.-t � ✓ N fi� t i%1� C) . G(�. —'i"I"O �7" J/!/ -) <br />�r�37ratt J'ian S.�Yt— !_S ��v {7E' CIFo7.,r'c� u,O c/l,•,�/,,, „ <br />.� lU� ei �- / , / / <br />� �i ✓I c E' �/OX i.i ��v �it !i'!I �i 51��c � � �„�Cc/ � i'" <br />�%!!�Q �i/U.� �T> inai/� 4��/�l7b�R��i <br />PERMIT I i VALI <br />EXPI�,�4T. •N <br />%� �83 <br />DATE <br />FOR 1 YElAR <br />Z-. <br />Thc undersigneC owner hereGy a9rees to hold antl save harmless <br />Ihe City ol Everett vom any nntl au claims lur damegos, cosls, <br />expenses, or causes ol aclion that may a�ise because ol installalion <br />and maintonance ol the improvement or other righ4ohwey use <br />hereto applied tor and luriher aS�ees ;o remove �amo upon notice <br />irom the City antl to replace puhlic pruperty damaged thereby. <br />E <br />CALL �OR INSPECTION <br />PGST A 259-8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />