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<br /> "'�'"` APPLICATION FOR PUBLIC WORKS PERMIT
<br /> � TYVe or vrinf cleady with ink � .
<br /> PRESS HARD•YOU AfiE MAKING COPIES pERM1T NO. �� �
<br /> PUBLIC WORKS
<br /> EVERETf,WASHINGTON /���� BLDG. DEPT. NO.
<br /> ❑ OWNER ❑ AGENT DATE ` �
<br /> APPLICANT/FIRM REPRESENTED � 7jLt��E _ �"6l,lE.YSo,c� i
<br /> ADDRESS /�U� C�C'F d y CITY �Vt�T7 TELEPHONE �S�' �J i
<br /> 7 I
<br /> HEREBY APPLIES FOR PERMISSION TO � }� l C,lJO 1"O,C('N /NTv ��«�'�— I
<br /> AT THE FOLLOWING LOCATION �='1 l `L�
<br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the fol!owing as applicable:
<br /> ` Property lines and street identity. " Topographic changes requiring cuts and fills
<br /> " Outline and dimensions of existing and other than normal foundation.
<br /> proposed structures. ' On•site drainage systems when required.
<br /> ' ' Existing and proposed utilities. ` Erosioqcontrol methods when required.
<br /> ' Centerline of abutting right of way. ` North a�oyv .: , ;, /
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<br /> �� S naNre ol Applicenl
<br /> PUBLIC WORKS PERMIT
<br /> CONDITIONS: I
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<br /> "`1J-`�'-t���'-�J --�—�' �-+�� The undersigned owner hereby agrees to hold and save harmless
<br /> . � : � i _ , , the Cily ol Everett trom eny antl en cia�ms for damaBes, coata, ,
<br /> , eMpenses,or causes ol aclion thel mey arise becauae ol instella�ion
<br /> � i . . , _ � , � . . . . . . . . . .. . . . . . � and maintenance ol Ihe improvemont or other riqhl-ol�wey uee
<br /> �� . . , y,:. . - hereto aPPlied for antl luriher agrees to remove same upon nolice
<br /> . Irom lhe Gity and to replace public property dameBed iherehy. .
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<br /> OV FOR CONSTRUCTION DA E ACKNOWLEDGEMENT OP CONDITIONS 3 �
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<br /> AP OVEDASCONST U T[D � DATE SIGNATUREOFAPPLICANT DATE
<br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR INSPECTION
<br /> 259•8811
<br /> �- EXPIRATION ' 7- '��-3 JOBSITE 24 HRS. BEFORECONSTRUCTION
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