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ir <br /> �. <br /> '' e"e`e" AppLIC/�lTION FUR PUBL�C WGFiPCS PERMIT <br /> Type or print cleady wilh ink <br /> �� PRES`S HAflD-YOU ARE MAKING COPIES y� �C p <br /> � PUBLIC WORKS PERMIT NO. G'��� <br /> i <br /> EVERETT,WASHINGTON � BLDG. DEPT. NO._ <br /> i O-OWNER O AGENT DATE i'�-�'7-�1 <br /> APPUCANT/FIRM REPRESFNTED �i�1?_lLSsnciat�°' <br /> �I — — <br /> � ADDRESS Z���t� '7'�,���;��'.t' ��Ty isverett TELEPHONE 252-11u6 <br /> HEREBY APPLIES FOR PERMISSION TO _ T Fve l i'il] d'irt and clean un brush, weather ➢criaittin;;. <br /> I� I ��:�ncu�r: �r_ll br ;�a.inutiir.od. �:fi:ects Lots ,5 thru 17, Itlock 'Ljl, ilat oi 'svemti <br /> i)i�is5.cn 'i. <br /> I ATTHE FOLLCWING LOCATION i'it;e Street `-outh of �he Ct�tLrch to ljth fltreet <br /> � Attach five(5) copies of preliminary plans for proposed work. Draw to scale and show the following as applic2ble: <br /> * Property lines and street identity. * Topugraphic changes requiring cuts and fills <br /> * Outline and dirc,ensions oi �xisting and other than normal foundation. <br /> proposed structures. ' On-site drainage systems when required. <br /> ' Existing and proposed u;:;�ties. * Erosion control methods when required. <br /> * Centerline of abutting right of way. * North arrow <br /> - � � /.f:�- <br /> ' Signa�ure ot Applicanl <br /> PUBLIC WORKS P�RMIT <br /> CONDITIONS: <br /> . . . . �1` . /lJv % � f/L L �c.�Y!'J/% — L c� G . <br /> c-,r i�' rii✓G Fi� < . <br /> - ._. - : it- : �i9in�j%/n� •E'.R'.c1'T/i,_) G V�.F'/.�'in�/J Gr �/f��. . . . . . . <br /> � . . , <br /> . <br /> �: � . . . . . , . . . � . . . <br /> _ _ ._. ._ _. ._ _�. _—__ _ •_. _ _ . - --+--- - -.. ._ _ _ .__ _...___.. . _ .. .. . _. . , __._. . . _,— . <br /> . . . . . , � . : _ . . . � . . : . . . .: . . . . . . . . . . ; , . . . <br /> : . . . . . . . . . . 1 � . . � ` . . ; . �. . . . . . . . . , . . . � . <br /> , . . <br /> � <br /> ; . . . , <br /> ._---- .___..�_. . :-r _,. ._._ .___- -_ ._ ,._.. ._._.__ . ..--_. -- -.... . . . .. . . . .. ... . _ . _. .. , . . <br /> ', �. . . .. � � . . . . �. . . . . ' . . . . . . . . . . . . . . . . . . . . . . . . . , ' <br /> i i___�-..��_.. . , . . . . . . . . <br /> The undersigned owner hereby a9rees lo hold and save harmless <br /> ii, � Ihe Gily of Everett trom any ano all cialms for tlamages, cosis, <br /> , . . . . . ezpenses,or causes ol action that may arise because of instaltation <br /> . . . . . . � � antl maiNenance of ihe improvement or other righ4ol-way use <br /> � � � - hereto apFlietl tor and luriher agrees�o remove same upon notice <br /> � � � _ _ . �-- Irom the City and lo replace public proUerty damaged thereby. <br /> y��`��-�.��' o-�v��'/ - <br /> , <br /> � APP , Vg � OR CONSTR ION � ATE ACKNOWLEDGEME O� CONDITIONS <br /> I gZ ---�.::�v�C_:����`_ ;= . = , �� <br /> � APPRO D AS CUNST CTED DATE SIGNATURE OFAPPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> i POST ON 259-8811 <br /> ' EXPIRATION �C - �'"��_� __ ��BSITE 24 HRS. BEFQRECONSTRUCTION <br />