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r <br />1 <br />°� APPLIrATION FOR PUBLIC WORKS PERMIT <br />Type or ptln� claetly wllh Ink <br />PRESS HARD - YOU ARE MAKING COPIES �� Z-�B <br />PUBLIC WORKS PERMIT NO. __ =� <br />EVERETT, WASHINGTON I I� BLDG. DEPT. NO._ <br />❑OWNER I�AGFNT DATE � J�_J JI <br />I /,-,,, <br />APPLICANT/FIRM REPRESENTED _ TFlk K���� WIII�'/Y�`� <br />ADDRESS ._�Z-�___�_Ss,_�� —__ —CITY ��tk�Sr�—TELEPHONE.��__��(�'1 <br />-�- <br />HEREBY API�LIES FOR PERMISSION TO __ _C'�(Z}��_� L_j( ��1Uf'Lt �J �_ L�! 'T Uj -�!La'�.L]AZ��. <br />-- -- - --- - -- -- --------- -- -----_.---. _. ___ ._ .---- <br />- r�{}� .- � f� T�� . <br />AT THE FOLLOWING LOCATION _ _J.>____•?W_ _ _ LS4_ _ _ -� . _ �_ ___G'V��� <br />Attach five (5) copies ol preliminary plans for proposed work. Draw to scale and show the tollowing as applicable: <br />! <br />• Property lines and street identfty. • Topographic changes requiring cuts and tllls <br />• Outline and dimensions of existing and other than normal foundation. <br />proposed siructures. ` On-si e drainage system� when required. <br />• Existing and proposed utilities. ' Erosi n control methods wh n required. <br />• Centerline o( abutting right of way. ' No h rrow � <br />- - � L1�i Q�l,=�-�i'�,_ <br />� Si ature ol Appli�enl <br />RKS P,ERMI <br />CONDITIONS: <br />1 . .�. N�t oPe.. c.�fl �r` o� �l �� :�.�� ��, w�11 be alluw��' fx eC�+� -�+r <br />. . . ��kC4N•",�o•� (�SN•� ia�' 'N \�n��a�l� ��nP�e` CfJS! -�♦ w�tf SyO�fvH, <br />(� C � 1 /��! � <br />1\1� p{i�v� N�•�.�y �ifOS�1M\) Ww)�- �< �OOfI�Y O� `PG1�r��Y <br />.1. CloS�.,o� ef{ eE. (l+�" �ve w 1,elwer.+ 15��' a..��' So�� i� a�pro.,r.i. <br />' aCAff�lG.c« �.�,} e� ��o�,S �,�,� P��-� �t ��o<i. a�.s� <br />. �'V`(a��ll�\N(�J �] �{�f �i4�\1\�CCI ��/� l7` \,�f I�,u6llt �.JU/R1 �I H�i <br />a ,. � `�e 4.� -� ,_T(c� (� � � E � � <br />. ✓• �-\JNt.�1 1\Vti O`. 1`P��` Q P`\ LTu\' � UVC(�/ Ip{� lAiN1F Vt M1I1..�I.N�hij. <br />;� �o a4l '>w��f�GCT �ur 0�+1 �! \'V.V\�'i lvr�r�cS =��srf�tar <br />. . . . ' cla'���oc� +I�b,+`p� � •,+-�; I�.�:�.SJ � � dpy� ��-. �rro.,--� <br />I � Jr�. Exe�P� as v.o�.,� o,�vQ ,�\\ wo.-1� s1.o�� be Pe.- P`a..s <br />, :.. . . . 4PP^°.,�� �' '�Y <br />, 1 (' The unAnrsipnetl owner hereby e0�ees lo holA and aeve harmless <br />�6SS�S �rrYa�a�rrcy - bldS 8— � 7 ZO t�e Cily ol Evarol� �rom eny ana nu cleima lar tlemepeq coele, <br />9- I b L O e.paraes, m wusee ol aclion t�al mey e�l�e beuuee ol Insl�IleUon <br />� •� �' ' 1 O — �S 10 ena memlenanca al Ihe ImOrovement or olAer rl0h4obwey u�e <br />' I 1 � � y LO �e'dlo 6ppLed lof an0 Iwiher eplBee lo remOv! uma Upon nolite <br />/ I L— O 20 �'�^� ���n GW and lo ren�eco nuhlic propeny demeyed Ihxreby. <br />�- <br />��-- S-3 _�/ � 3-� i z a <br />PROVE FOR COYS CTION � ATE AC OWLEDGEMENT OF ONDI IOk <br />__ <br />i <br />� _ ��� - �`-� F�1�__ `� •.� k�1v�—�_���/�?� <br />, JATE 51 TURF.OFAP LICAN L OATE <br />PERMIT IS VALID FOR 1 YEAR <br />POST ON C LL FOR INSPECTION <br />259•881 1 <br />.l(7RRITF .,.��..n r+rr�nrnnuoTn�V�T�n�e <br />1 <br />