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`1 <br />r <br />72 <br />L <br />r <br />L <br />1 <br />APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clesdy wilt, Ink <br />PRESS HARD - YOU ARE MAKING COPIES �S' <br />PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON <br />OWNER O AGENT DATE /9_37`52- BLDG. DEPT. NO. Ii,J00 <br />APPLICANT/FIRM <br />�REPRESENTED llws _ 471?L�S_ � <br />ADDRESS �,iE Ei%L %% Mlr}tL uf/q-CITYEdE/"E/r TELEPHONE .7- <br />HEREBY APPLIES FOR PERMISSION TO A!! ! .*4 3S� 4 (DC Ct7NCrPr �rf/!/dW4Z <br />AT THE FOLLOWING LOCATIONN!EgjtEWE �y,q_ . (�Dg_ 73 d S i. <br />Attach live (5) copies of preliminary plane for propocerl work Draw to scale aIid show the following as appllcable: <br />• Property lines and street Identity. <br />• Outline and dimensions of existing and <br />Proposed structures. <br />• Existing end proposed utilities. <br />• Centerline of abutting right of way. <br />rONDITIONS: <br />BLIC <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On -site drainage systems when required. <br />lo. .:ontrol m thods when required. <br />\rt atw;Q00", <br />RKS PE <br />/. �r/rn • �// rosr �)r .>< ../.rn /.s A. ./(, be dec, <br />2. GrMKrt� J/�of Onc✓ /bOf �O�L �I-.a.�r nsf /L 'Aa 60 e110 Pe,1,-ki2-A <br />�C7iRrnnSG Si .�n�Q -ry [�, (j, On q 1_ <br />ap" <br />-/ <br />.j. flAy t70 N,.r3t .. 6r'yc /.rJP O'vi+ /: 6J,v //oe C. .v/. al,/ eoNJ wC uq MNS% 6e /r�?rah/' p <br />Y. .YC6ri5 A. <br />If -It C4 r<Ojn /i, <br />F STRUC I%A� L <br />ROVED AS CON UCTE 3 A" E--- <br />PERMIT IS VALID FOR 1 YEAR _r <br />EXPIRATION <br />P •, j. <br />V a/Vc. iuk -7/p QCT/ f tilde, <br />The undersigned owner hereby agroes to hold and save hermlese <br />the City of Everett from any and nu claim* lot damage&. cod& <br />expenseq, or cause t of action that entry arise bepuse of Installation <br />and maintenance of the Improvement or other right-ol-way use <br />hereto applied for and further agrees to remove some upon notice <br />From the City and 10 replace publlr• property damaged thereby. <br />OF CONDITIONS <br />POST'ON I CALL FOR INSPECTION <br />259.8811 <br />JOBSiTE <br />24 HRS. BEFORE CONSTRUCTION <br />1 <br />J <br />L_ A <br />