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�i <br /> everett APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Print cloarly wilh ink ' <br /> PRESS HARD-YOU ARE MAKING COPIES pERM1T NO. ���� �����' <br /> PUBLIC WORKS � - <br /> EVERETT,WASHINGTON BLDG. DEPT. NO. <br /> O OWNER ❑ AGENT DATE f�� �`�`�. <br /> � <br /> APPLICANT/FIRM REPRESENTED LE� .S<'�r'�.��c�n-' « <br /> AdDRESS - <br /> `'�`>�'� / `s2f E T T �4/�� CITY TELEPHONE �SP- lc-�'yi <br /> �ili�'!" �'�i�`'�h' � /'�'/� r--- <br /> HEREBY APPLIES FOR PERMISSION TO —� <br /> �i;/'�C%�'iri���. -�n•/-� -�rn��4 - <br /> ATTHE FOLLOWING LOCATION Si�'Tr �F'�'f���' �� �/'� ��i`�' �'� "` <br /> ��';�(��.�- �'�t^L./ �`v�.�'�_%T . <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. " Topographic changes requiring cuts and fills <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 /> ' Centerline of abutting right of way. • North arrow ,. <br /> • / • , < „' t C <- <br /> i i ��•.", � , . . �_.. <br /> = Slgnature ol Appllcent <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: _ <br /> � � . <br /> . . . . . . . . c � �. <br /> , , rv <br /> I ' � . , � � . � � � � . ' � � I {, r / � v <br /> ��.__i.�:-•--�-- - ,__. . �.� !•1 <br /> ( � :� ; j � �� l . .. . . . . : �� � � '� �� � � V ��. <br /> � � : , . . . C �i. � � <br /> .� � =: i .. . : . � � : �� , � r��` � � �� � �� <br /> , '� �_' , ;:� _ � � _ . :_ . . : � �� � � r � , <br /> , ; .=:-1- . . . -, _ -� `� � �l L�' �` <br /> , . t � : � � �� : � � <br /> : . . � �'- <br /> -:_, .T-, _ . . (� ,� v� ' t ,' � �- z <br /> i : j : . E . . . ; . � , '���`3 _ - <br /> ` _ � , . . . . : . _. : . .� _ . . <br /> - �"— �T���_� i 7he untlersigned owner hereby agrees lo hold and suve harmless <br /> ! I I ; ' : � : i 1he City ol Everelt trom any ana au ciaims lor damages, costs, <br /> ' 1_� + ezpenses,or causes ol action lhel may adse bowusa of instellallon <br /> � � � <br /> �� J _�. ._` __ __ „ �._ , . and ma'nte�ance oi Ihe improvement or othor �ighFo4way use <br /> ' ' . harclo epplied lor and lurt�er agraes to �emove same upon nolice <br /> � � . � . , � � Irom Ihe City end lo replace publlc property demegetl Ihereby. , <br /> APPROVED F�OR CONSTRUCTION DATE ACKNOWLEUGEMENT OF CONDITIONS � <br /> APPROVED AS CONSTRUCTED DATE SIGNATURE OF APPIICANT DATE <br /> PEkMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> EXPIRATIOPI JOBSITE 24HRS. BEFORECONSI"RUCTION <br />