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everett APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES Z <br />PERMIT NO. <br />PUBLIC WORKS S <br />EVERETT, WASHINGTON BLDG, DEPT. NO. <br />yQOWNER ❑ AGENT DATE <br />APPLICANT/FIRM/�REEPRESENTED <br />ADDRESS-_9-rct-)/ a ,z CITY �yG TELEPHONE � Z� <br />HEREBY APPLIES FUR PERMISSION TO <br />AT THE FOLLOWING LOCATION . �zf <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following as applicable., <br />• Property lines and street identity. <br />• Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On -site drainage systems when required. <br />• Erosion control methods when required. <br />• North arrow <br />PUBLIC WORKS PERMIT <br />;QNDITIO.NS; _. . <br />is <br />Lz <br />s <br />