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°°w APPLICATION FOR PUBLIC WORKS PERMIT <br />PU� WORKS <br />EVERETf, WASHINGTON <br />�OWNER ❑ AGENT <br />DATE <br />APPLICANT/FIRfA REPRESENTED <br />TyOa o� onnl clearly wilh ink <br />PRESS HARD • YOII ARE MAKING COPIES <br />PERMIT NO. __- 3� � <br />�au/ R� BLDG. DEPT. NO.�f�UA�`—S <br />� J- <br />r�f�� �1% G�,�,G�-�v �so n� - --- <br />ADDRE�S __aC_ 7 Q�-__���y. ___ CITY��i����_TELEPHONE 3��`?G y� <br />HEREDY APPLIES FOR PEFMISSION TO �' O� �/ �Cd N�6 ��� � 4_�_ HI__��. U.,S` <br />_ _ � �G'.�� - - — <br />AT THE FOLLOWINC LOCATIO� � y Q 9 7J y y F— v�� ��? _� <br />Attach tive (5) copies of preliminary plans for proposed work. Draw to scale and show ihe following as appHcable: <br />' Property lines and street identity. <br />• Outline and dimensions of existing and <br />proposed structuras. <br />' Existing and proposed utilities. <br />• Centerline ol abutting right of way. <br />• Topoqraphir changes requiring cuts and (ills <br />other than normal toundation. <br />• On-site drainage systems when required. <br />• Erosion control methods when required. <br />• Norih arrow <br />%�!' ✓ / J � r <br />% �."%�..I��.._-- <br />$iynalwe ol ApO��wnl <br />CONDIT,on,s: PUBLlC WORKS PERMIT <br />� i/? /,�t".,�c <br />�GD /N1/�i=7� T �-N <br />_J <br />'� �l� � _t"lz�ls3 <br />, <br />A�PROVEG A.3 CON RUCTED� DATE <br />°ERMIT IS VALID FOR 1 YEAR <br />PIRATION <br />>'�'l3L /C %� /G�i' <br />Thr unrlr�siUnerl owner hereby agreos lo hultl end 6eve �ermlana <br />INe GIy ol Eve!retl Irom any ena ell eleims lor demeqee. eoel�, <br />e.nenses. or cau•es ol acbon 14a1 mny ense 6eceuee ol Inrlsllellon <br />anA maintena�ce ol I�e ImO���vement or othar rlphl�obw.� use <br />�erelo appbntl :or end lurlher B�fea! 10 �amUVe eem! upOn �iollC! <br />Iwm Ihn Cily an0 lo rePlece pu611c property demepe0 I. .roby. <br />ACKNO LEDGEMENT OF CONDITIONS <br />�, � � i <br />bL � . �� f.,,ac �Cc � !� C� �.�.' `.— _ <br />SIGNAT�RE OF A'PPUCAN7 DATE_ <br />POST ON <br />JOBSITE <br />CALL FOR INSPEGTION <br />259-8811 <br />24 HRS. BEFORE CONSTRUCTION <br />1 <br />