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n <br />r <br />r <br />L <br />IN <br />L <br />everett APPLICATION FOR PUBLIC WORKS PERMIT <br />© Ely with <br />h m.. <br />PRESS HARD <br />- U D YOU ARE MAKING COPIES PERMIT NO. <br />PUBLIC WORKS BLDG. DEPT. NO.— _ - <br />EVERETT, WASHINGTON 3 �� <br />OWNER ❑ AGENT DATE iff <br />APPLI-ANT/FIRM REPRESENTED .//�LL�-S--�,'"=�'- 'GI-" "---- � G <br />ADDRESS'f-��' x�-*--CITM 'V P —TELEPHONE-��' 2 /Z <br />aelur.7 •t�A� <br />HEREBY APPLIES FOR PERMISSION TO LA)STf}� aS c <br />4o7 73 = s�. S w <br />AT THE FOLLOWING LOCATION ioS-_�-LJ__v�'Y="-^"" - -- <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 />• Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />CONDITIONS: <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On -site drainage sys�tems when required. <br />ion control meXhods when required. <br />Nort ow �� / 0 <br />lit <br />/ ly IPPrY- <br />,2eli ela'sPhype+T Gii t <br />6E, c/ea,1'10 <br />o?. �Oot_TVr 'Aay.,.rfc '"ASrA 6r <br />o _we A <br />/S HOT <br />60 r /7-b <br />3 /Qny glvrHtl3e 6recf tG'FC � 1'd�f ' <br />J / L J / <br />/ e,ecce -r—s ✓a Lt/AC <br />AYNSi e- <br />rl�oni� � <br />S. ,QAusr wa • sP. ,,. a.r/V C 60 K o6/4z /%o/ yrJ,y/ <br />r lO r� y/f iT IPA The undersigned owner hereby agree& to hold and save harmless <br />J the City of Everett from any and an calms for damages, costs. <br />/j Ma /- A erAJ n OI expenses, or causes of action that MAY ads& because of Installation <br />1 and maintenance of the Improvement or other rigMof•waY use <br />/O r � .3{D hereto applied for and turtner agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />PL NDI <br />APPROVE R NSTRUCTI N ATE KNOWLE /ENT OF TIQNS <br />SIGN OFAPPL ANT DATE <br />APPROVED AS CON TRUC DATE <br />CALL F R INSPECTION <br />PERMIT IS VALID OR 1 EAR POST ON 259.8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />EXPIRATION <br />I <br />-1 <br />I <br />J <br />L. <br />J <br />