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everett APPLlCATION FOR I�UBLIC WORKS PERMIT <br />� TYPe or print claarlY with Ink p <br />PRESS HARD - YOU ARE MAKING COPIES pERMIT NO. o°Z � <br />PUBLIC WORKS <br />EVERETT, WASHINGTON f, �j BLDG. DEPT. NO. <br />��OWNER ❑ AGENT DATE �?- 1l — o � <br />APPLICANT/FIRM REPRESENTED d'<--=G n iT.c�C�� /i� _ <br />ADDRESS � ���1�t-z ��CITY �v�/?�/�TELEPHONE � 5^�] � <br />. � <br />HEREBY APPLIES FOR PERMISSION TO -uI�-� � -��; �n � � —�! � � <br />�T lv�-iC' (\ o ii � P ti.^ u� 2 1 O�n t y _ c . <br />ATTHE FOLLOWING LOCATION <br />Attach five (5) copies of preiiminary plans for proposed work. Draw to scale and show the following as applicable: <br />• Property iines 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 requfri�g cuts and fills <br />other than normal foundation. <br />* On-site drainage systems when required. <br />' Erosinn c�trol methods when required. <br />` Non: � ar � � �� � <br />i <br />QONDITIONS: . _ <br />�.: ...... <br />�...;. .. <br />i..,,. <br />4 l .....�... <br />� �� .... ................. . <br />�.-•--'-... ...... <br />�......... . <br />�. ----- ---.. __...:....._.'___...._.. <br />�_T..:. '._ _..._.... '._:...... <br />.., <br />I:.....�..� .. .. <br />�_ . . . . <br />�:. �. __.. _ �."'___ _' _. ..-. . .. __ .____ _.. .. ... ._ . . . <br />� • . .. , . . , . . . . . ; . . . . . , . . . . <br />� . . . . . . . . . . . . . . - . . . . . . . <br />��,�'i��� � . . . <br />/ l 3 „73-�Z- <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION 3-a3� �3 <br />. _ ._. � <br />. . . . � <br />. .. ; <br />. ...�. . ; <br />.... � <br />. . . _._.__ . _.-- ���---�--� <br />... :,..' ; �� <br />._..:�-�3����`. , <br />... },"� <br />i <br />. - ----- � - •--� , �-; i <br />. .... .._ � <br />; . . . . . . � i � � , <br />The undersigned owner herehy a9rees to hold end save harmless . <br />the Ciry of Everett trom cny and ail claims for darneges, costs, � <br />expenses, or causos ol ecUon that may adse becausa o! installation � <br />antl maintenance of the Impmvement or other riaht�obway uso ; <br />hereto npplied lor and further afl�ees [o removo snme upon notice <br />Irom Ure Cily and to repince public Uroperty demaged thereby. � <br />OF CONDIT ONS � � <br />y�� <br />�' � _.. �� -.-�'<_�7 � <br />CALL FOR fIVSPE�TION <br />P05T ON 259-881'I <br />JOBSITE 24HRS.BEFORE�ONSTRUC'f10�J <br />� <br />