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°"°'"" APPLECATION FOR PUBLIC WORKS PERMIT
<br /> � Type or print ciearly wil�ink
<br /> PRESS HARD-YOU ARE MAKING COPIES
<br /> PERMIT NO. �'� � 3 �
<br /> PUBLIC WORKS
<br /> EVERETf,WASHINGTON //
<br /> �OWNER ❑ AGENT DATEH-Z� �2 BLDG. DEPT. NO. _
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<br /> APPLIC4NT/FIRMREPRESENTED �ru�ycir /� , 7(��� ,.., :�,
<br /> ADDRESS���!�__� ��-�J - CITY��-�o�+,.7�" TELEPHONE�2-S�9/
<br /> HEREBY APPLIES FOR PERMISSION TO �/�.�-�•-<.�e���_T-� -. -G,,���y..,r�>�if�J
<br /> G.:C.Q-SiYG�^"� _ O L
<br /> A7 THE FOLLOWING LOCATION ,L��,���9-Sx_�� ��-f ��LL �e ' ,�- --a—.�z 9��L
<br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show lhe following as applicable:
<br /> ' Property lines and street identity. ' Topographic chanfles requiring cuts and lilis
<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. ' Erosion control methods when required.
<br /> " Centerlire of abutting right oi way. ' North arrow /
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<br /> �1 t�`G-Z-�_`�/J ���Ic./..�Ju%Y'(!�'�
<br /> S�B�ature ol Applicant
<br /> PUBLIC WORKS PERMIT
<br /> CUNDITIONS;
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<br /> + , , , ; y ;_._y �� J , , ; � , , �, # , . . . . The undersignea owne� hereby agrees to holtl and save harmless
<br /> i ; , . , ' . . . � . . i . . � . . , � . . � the City ol Evere�t Ir�m eny antl an claime lor damepes. cosis,
<br /> . . _ . , . . . , . . . , . , � . , . . . . expenses,or causes of actlon ihat mey arlae oeceuae ol Installallo�
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<br /> end maintenence ol Iha impmvemenl o� olher nght�ol-way use
<br /> � � � � � � � • � � � - � . ' • hereto ap0��ed lo� end fuA�pr egreea lo remoue same u0on noticc
<br /> �--: _j ; i' Irom the City and lo replace puhlic proDehy dameped Ihereby.
<br /> '�a �/!l G— ba) � ,.!� �
<br /> � �-�A RO �DFORGONSTRUCTION DATE ACIWOWLEDG[PdENTOFCONDITIONS �
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<br /> AP ROVED AS CON UCTED � DATE SIGNA URT E OF APPUC4NT - DATE
<br /> PERMIT IS VALID FOR i YEAR CALL FOR INSPECTION
<br /> POST ON 259-8811
<br /> EXPIRATION _ JOBSITE 2qHpS. BEFORECONSTRUCTION !
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