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everett AP�LICATION FOR PUBLIC WOFiKS PERMIT <br />� TYPe or print clearly wilh ink p <br />PRESS HARD • YOU ARE MAKING COPIES pERM1T NO. '? �/3 <br />PUBLIC WORKS � <br />EVERETT, WASHINGTON BLDG. DEPT. NO. <br />❑ OWNER ❑ AGENT DATE �' 1�=_ � 3 _ <br />APPUCANT/FIRMREPRESENTED �Q-�e_ Mu���^�? -� C�certF Sk� 5�,,,� <br />ADDRESSb��v �=`�����er.� wa. CITY ��r'�eM TELEPHONE ��3-�'�'�'� <br />HEREBYAPPLIESFORPERMISSIONTO �Q-��- :�1"u...\c�t� a,�-e�- �cro�� �w..itv�� <br />ATTHE FOLLOWING LOCATION %�IOC� L�er ree,n wa <br />Attach five (5) copies of preliminary plens 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 />Signature ol APPlicant <br />coNo�rioNs: PUBLIC WORKS PERMIT <br />�/"'%I✓liMNw� :� k / `%C.vPn�fW1 S�ic�// 'JC 3 i•�c^tS . I. . <br />�. 7!� vi�Si 01` I �' . <br />. '!"_:' '-, �: <br />n i <br />S/i5hi sn,.�/r �s �v�.� �ie i„n�..i•fn;...�ol� t{:rProx „3'_`�'ouaed-e���l � �, <br />/ r � <br />E,.IPijfPP�� G(lw% P[YSC Stf/'�� C.' . _� <br />/�ew Pa�e..��.✓J �r � /� -�e�.�Fdr �d v� .K.v�r-l� ewsl)�J � ' <br />i <br />C✓eirrtr., Gv.a� ��Ct✓P..,P�^�' u�e�i' o'F �'}�i5f-IN1 e�t�f�G 5tr���' � .-� <br />/ c/ <br />�J.��9 jraJf in�tsF ��' aPP/uvr.�� (�� Pib/.i: Guu.k> ..e.. o�a'c�a+i � �. . ���. <br />�: �ri.- ^f'o . 5�+tr �-in` �R✓i i S / <br />C'ct r: � s ,T�� J� � r.r ., u.�,;h,� G p�tr ���.r „ ,r �• K t� a,�%i� <br />/ <br />s .'���'1 / � } � UC�� <br />/ <br />�,�- ` �S� � �, / . <br />":�� �'�j <br />i� _ � .� ///� _ �� <br />PERMIT IS <br />EXPIRATION <br />Tf <br />' 3/ila3 <br />1 <br />c'��e: Ji.r� s���e. <br />The undcrsigned owner hereby ag�ees lo ho�d and save harmless <br />the City oi Everett trom any and au cialms lor damages, costs, <br />expenses, or causes ol action thal mey arisa beceuse of installellon <br />and mainlenance ol Iha improvement or other righl-cf•wey use <br />hereto applied lor and lurther agrees to remove same upon nollce <br />Irom Ihe City and �o replace pu6lic property dameqed thereby. <br />or-, <br />CALL FOR IWSPECTION <br />POST ON 25g-g811 <br />JOBSITE 2aHRS.�tFORECl�NSTRUCTION <br />