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r <br />�ST <br />'*d t <br />7 <br />w , F`: <br />�y <br />everett APPLICATlON FOVR PUBL9C WpRKS PEFiMIT <br />� TYPe Or Print CleeriY wilh Ink <br />PRESS HARD - YOU ARE MFlKING COPIES �3 � <br />PERMIT NO. <br />PUBLIC WORKS <br />F.VERET'i, WASHINGTON �/��., BLDG. DEPT. NO. <br />❑ OWN�R ❑ AGENT DATE _ �—�_%�3-- _ <br />APPLICANT/FIRA9 REPRESE�!TED <br />ADDRESS <br />n <br />HEREBY APPLIES FOR PERMISSION TO <br />ATTHE FOLLOWING LOCATION <br />LEPHONE a ��-7 � �1 � <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following <br />t 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 />CONDITIONS: <br />-,��/ �'% <br />A�R VED •O -CON UCTIO DAT <br />/� " r � Z. <br />APPROVED AS C N57RU ED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPI RATION <br />� ' <br />* Topographic changes requiring cuts and fills <br />othar than norrnal foundation. <br />� On-site drainage systems when required. <br />• Erosion control methods when required. <br />* North arrow/1 /I � <br />RKS PERMIT <br />. .�i...� i � . ....... <br />' <br />.�,. . ,......, <br />. i _ '' <br />... . . ..... . . . .... . .._.�... .-� . , S . __ .. <br />.... � . _.. . -::- , ' _.i . . ��, . f . �.- . . .,. <br />� The undersigned owner hereby a8reec to holtl and save hermleas <br />`, the Cily af Everett trom any ana au clalms for damege0. coata, <br />_ expenses, or causes of eclion that may arlse beceuse of Inatellatlon <br />� end meinlenance of the Improvament or olher riBht•of•wey uae <br />' hereto epDlied for and lurther egrees to remove seme upon notice <br />' Irom lhe Clly and fo reDlaca public property demagad thereby. <br />�� <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORECONSTRUCTION <br />i � <br />'� .. <br />Yl <br />2� <br />;� i _',: <br />�F <br />'� :a <br />�. <br />, �.. <br />...�r �� ,� � <br />:,: <br />s° <br />x <br />