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� <br />ev�rett APPL.ICATION FOR PIJBLIC W�RKS P�RMIT <br />� TYPe or print clearlY wilh ink <br />PRESS HARD - YOU ARE MAKING COPIES pERMIT NO. �3 `' � <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. NO. <br />-z� I r,� d3 <br />DS.OWNER ❑ A3ENT DATE _ ___ --_ <br />� <br />APPLICANT/FIRM REPRESENTED __ � _K���E=� _—C�— <br />ADDRESS ��� ��r LA� CITY 5;7�=K.�=t�__TELEPHONE='��"e1G�U <br />HEREBY APPLIES FOR PERMISSION TO I I�) S � n�-L 7i — y �� ��� « I�CC ILF� r _ <br />i�� (��r-� C k- C2(= S I h� 1..�.)lkl. �C <br />ATTHE FOLLOWWG LOCATIUN � ��'-� � ,_J �� ` "1 V��• — <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />' Proparty lines and street i�ientity. ' Topographic changes requiring cuts and fills <br />' Outline and dimensions of existing and other than normal foundation. <br />proposed structures. ' On•site drainage systems when required. <br />* Existing and proposed utilities. * Erosion control methods when required. <br />' Centerline of abuttina right of way. ' North arro <br />��( ���'/ =.�2� /.YI20�/LG} <br />"'--\ Signalure ol Applican� <br />coNoinoNs: P'i1�LIC WORKS PERIVIIT <br />CWNF�? A�a�LFE� FtrJy' �Fh�.��vlr�� <br />-(C F/ic 1 �l � nT� �kGc��S TO <br />�� ➢L�CK�2� <br />c, i � �+.�iT�=-R <br />o-rH�fZ U7iL ��i l�,S wr�l_.. g�. <br />��,z i{�'��. ��P�_�s�_� � � <br />I � 1 1 <br />. , _....... . ' • <br />, . ,... � _� .... �...� <br />F�� I �{ ��a-z �c�i��; -n.{� <br />`�� - ��J �� Ar,���r'� Dtil <br />PERy11T !S <br />EXPI RATION <br />,� <br />g�. <br />�. , <br />t <br />_... . <br />� ' <br />i <br />M,_ z-�!`o '�3� <br />RC,ciC� �',� [,�ir� <br />;a,— o,f,r��.�_ � �. �v�� � � � <br />FOR 1 YEAR <br />The undersignetl owner hereby ag�ees to hold and s��ve harmless <br />Ihe Cily oi Everelt tmm any ana au clalms lor damages, cosls, <br />expenses, or wuses ol aclion that may arisa Gecausa ui Inslelletlon <br />and maintanance of Ihe improvsment or other righFobway use <br />hereto apflied lor and lur�her agreeb :o remove sarae upon notice <br />f�om ihe ^ity and lo replace public property dameged ihereby. <br />�4G�:1 �'W�� D�ENT QF CONDIT ONS <br />I/ <br />��G � �z �-Gz -r! � � ��"S�3 <br />SIGNP.TUREOFAPPLICANT � DATE <br />CALL FOR INSPECTIaN <br />POST On 25g-8811 <br />JOBSITE ?�HRS.BEFORECflNSTRUCTION <br />