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�i �''. c��_% i�� <br />�i-�� �_�_. 1't-:l'_;.,ri r t�._+-�K, � . <br />�e"e"" APPLICATION FOR PllBL�C WORKS NEL�MIT <br />Type or print cleatly with ink ` <br />�/ PRESS HARD - YOU ARE MAKIIJG COPIES � <br />PUBLIC WORKS PERMIT NO. <' %' Z� �-- <br />EVERETT, WASHINGTON j � j � <br />d;OWNER ❑ AGENT DATE __y� i'L�l�:'_ �__ BLDG. DEPT. NO. <br />� � �y,�� <br />APPLICANT/FIRM REPRESENTED _�a�._�� �c�;,��__ _ __ - <br />_ _ _ _-- ---- — <br />ADDRESS `��>�.=��,�{j�1=�`� �•L: CITY •�C7S1'�Q�� TELEPHONE ff'�}�6�. <br />HEREBY APPLIES FOR PERMISSION TO __`�� `i U P �1:? `�.G C'�.� `j �� ' <br />ATTHE FOLLOWING LOCATION _�',��7 �-"" r•��� ``_�\ r� t} q �, \�" <br />—�--L—�-�---.� _._,�� ' - <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. ' Topographic changes requiring cuts and fills <br />* Outline and dimensfons of existing and other ;han normal foundation. <br />proposed structures. ' On-site drainage systems when required. <br />` Existing and proposed util;:ies. * Erosion control methods when required. <br />* Centerline of abutting right of Grsy. * No�ih arrow <br />.� , <br />� i <br />�.�_ZG_-� ,-.l . � �; ��i � � --- <br />SignaWre ol Applicant <br />PUBLIC `WORKS PERMIT <br />CONDITIONS: <br />�'� �. l_) �.� <br />.. _. . . . . . . . L _. <br />Pill may be placed on the sites as desia. <br />� � � � � - � � � � � �lan, OrdLY, - NO PILL is to t,b placed i.r. . ��� � . . � . <br />' ' ' ' ' ' ' 'Any other�fillin�* i.ill requiris ad6itional }�ermi.ts <br />and �3etail plans for. hand7.in9 of the e:;istinq cu2c <br />�. �,�AZ��C �� ,X�pf' !��``- <br />, -. <br />1 , <br />, _ . _ _._._– �. �_._. . <br />c��v ti "�.�� ._ _��� L <br />, `- �-- r ��, . <br />..._.�_ � <br />� __ ._"'_'--•-`_ — - . � ,1Y kA�, <br />, 7 <br />_ � , �. � <br />��� �. �.� ��e��'('6b`i--- . F' 1'Iy �`/G.�T The undersi�ned owner herebY �grces �a hold and save harmies5 <br />-_� . . ��� �•,v�� Ihe City of Everelt rrom any ana au ciaims fm dama�es, costs, <br />_'._ � � .�.: <br />� �"��� � � I expenses, or causes of action thal may arise because ol installalion <br />: iand mainlenance of t�e improvement or other righl-ol-way use <br />_ ._. _, ���"'--�-,._, hereto applied lor antl furiher agrees to remove same upon notice <br />� �. ��-�"—'-- , Irom the City and to replace public pmperty damaged thereby. <br />D <br />PEFtMI'i' IS VALID FOR 1 YEAR <br />EXPIRATIOfV ' � � %'�'�` " <br />�" � <br />ACK�NOWLEDGEMENT OF CONDI'(IONS <br />��l -Ji:�t:�`i J1Gv�.�. �`. �.�,..,�`� ;:l_.. t c 1..;.'<;� <br />SIGNATUREOFAPPLICANT � DATE <br />POST ON , CALL FOR INSPECTION <br />JOBSITE 259-8811 <br />24 HRS. BEFORE CONSTRUCTION <br />