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l�"(�Q� 1v� -- -�V�I <br />everett ,qppLICATI4N �R PUBLI�WORKS PERfRIii'f <br />� TYVe or print clearlY with ink � <br />PRESS HARD • YOU ARE MAKING COPIES $� g�q (� <br />FcRMIT NO. _ <br />PUBLIC WORKS <br />EVERETT, NIASHINGTON BLDG. DEPT. NO. <br />❑ OWNER WAGENT DATE � ' 3 ' <br />APPLICANT/FIRM REPRESE�!TED _ ��1<s1 ����� �N�r <br />ADDRESS ��� �� K � CITY �C..i�QKr�TELEPHOVE <br />�5�,�a // 7 _ ST �/7�� (-G�� '7 7z5 ;o '; <br />HEREBY APPLIES FOR PERMISSION TO <br />,. . � / ,. <br />ATTHE FOLLOWING LOCATION /�'z� 3�UOA'�,t't �-� GU�j E//���7'7%""— _ <br />Attach five (5) copies of prelirninary plans for proposed work. Draw io scate and sliow the following as applicable: <br />• Property lines and street identity. <br />, * Outline and dimens�ons of existing and <br />' proposed structures. <br />' Existing and proposed utilities. <br />* Centerline of abutting right of way. <br />PUBL.IC <br />* Topographic changes reouiring cuts and fills <br />other than normal foundation. <br />* On-site drainage systems when required. <br />* Erosion conirol methods when required. <br />. ni,..�;, e...,,.. _ <br />iT <br />CO_NDITIONS; _ . . <br />. . .�er ;�- �of \ e�- �a�ar F_ro5�o�-. �:o..,ro� <br />+ . . . . �� � Cac41N` . OT` ���� �.1�� <br />` �. J � <br />- -,'__. . . . . . :P�T PI �v. �.�ro„p � <br />� ': .: ; <br />I <br />; � � ; <br />� :__ r __ : . : _ <br />r�',; �: a :� �: � .. <br />, � ; r <br />f � � � , �_..: <br />� .-1 = �- __ :._ <br />�.. .' ..' . <br />� , <br />: : :::�:: '':�;._ <br />.. ,� , . � <br />r ...._ ___i_ . <br />_.__ __ _._.._.. <br />-,- <br />::: ".;.::{ „ ;:: <br />.. . ....;...:,.._ <br />_ �--T---, ----, -•---. <br />... _ .. :, ...... <br />PEF�MiT IS VALQD FOR 1 YEAR <br />EXPI RATtON <br />�/ <br />li-3:�-81 <br />The undersigned owner herehy agrees to hold and save harmless <br />Ihe City ol Everel� Irom any ana au clalms lor damages, costs, <br />expenses, or causes oi action that may arise because ol instolla�ion <br />and mainlenance ol ihe improvement or olhor righl�of�way uce <br />harelo applied for and ludher agre�s to remove same upon notice <br />from the Cily and to re0lace public propedY dameged theraby. <br />ACKNO.,NLE G�tuIENT OF CONDITIONS <br />' �/ '"�" , �ccrc�..�-_,�' /� -�3/- ts ! <br />S�GNATUREOF'APPLICANT DAiE <br />CALL FI�R INSPECTION <br />POST 0�� 259-8811 <br />.idS517E 24HRS.BEFORECONS7RUCTIOP! <br />