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, _ . . _. _ . . . . . . _ . . _ . - � - - -------l <br /> � everett qp�pLICATION FOR PUBLIC WORKS PERMIT <br /> Type or Grint clearly with ink B�/ <br /> � � PRESS HARD -YOU ARE MAKING COPIES � � � <br /> , PERMIT NO. <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON BLDG. DEPT. NO.� � � <br /> ❑ OWNER � AGENT DATE 3���^___ _ - <br /> APPLi;'.ANT/FIRM REPRESENTED _S7'p.��..��N�el_ _ ____ <br /> ADDRESS _�/{ c�c,r�1 l�vb• CITY t=i/� TELEPHONE �r�-y..7Ag. <br /> HEREBY APPLIES FOR PERMISSION TO �/��T cx�ITi�� 0��� _ <br /> / <br /> ATTHE FOLLOWING LOCATION LSO� L4���A!,o <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. * T'opographic 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 /> �� .�. <br /> j% � �, <br /> --'�.-;����'� � - <br /> /' Signature o Applica�nt <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> � . . . . . �C 1 J Q w w w �c�'�-�. "'�'o �9 e G W� A Xi 1m u ..-. o� <br /> , ; : . . aQ -��e �- w��c �- ��Per�,� I�� e. <br /> �:� �._: . : <br /> !- -_: : . . i � ,� b � <br /> � <br /> � � ' ---. ` � / C� � L �J S ��L / ���`_ � <br /> . ' � <br /> �: . ;_ .�. . . . ` 0S /� .� �v � / �S ���� 7 �� �� <br /> . � � - <br /> � <br /> , , � . The untlersigned owner herehy a�rees to hold and save harmless <br /> . . . . Ihe Ciry ol Everett irom any ana au ciaims for tlamages, costs, <br /> ' � . . . expenses,or causes ol action Ihat may arise because ot installation <br /> � � � �� � � - � � � � and maintenance ol ihe improvoment ar other righl-of-way use <br /> � � � � � � � herelo applietl lor and lurther agrees to remove same upon notice <br /> j`'� / � Irom the Ciry and to replaco public pmperty tlamaged Ihereby. <br /> ' �/ <br /> `_--`� �'� .-� <br /> -�-�?�' ��.� �,i/�z- <br /> �� � APPROVEDFO C NSTRUCTION DATE ACKNOW�EDGEMENT.OFCONDI?IONS � <br /> /'��� � {/ -- <br /> �,"� �- °- 6'j_ <br /> %,� � _ <br /> � APPROVED AS CONSTRUCTED DATE � $IGNATURE OF APPLICANT DATE � <br /> PERMIT I� VALID FOR 1 YEA�i CALL FOR IN�PECTION <br /> � POST ON 259-88i 1 <br /> EXPIRATIOfV � � � � $ 3 JOB�ITE 24 HRS. BEFORECONSTRUCTIaN I <br />