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everett APpLIGATION FOR PUBLIC WORKS PERMIT
<br />Type or print clearly with ink �j 1
<br />� PHESS HARD - YOU ARE MAKING COPIES (, �( ��/�
<br />PUBLIC WORKS PERMIT NO. _
<br />EVERETT, WASHINGTON BLDG. DEPT. NO. �'�' � a O�
<br />❑ OWNER �d'AGENT DATE __ ��__� -��
<br />APPLICANT/FIRM REPRESENTED r,.xC-�— C2�.!_�.NC�_�c�N_I(_�v_LG�—. __
<br />ADDRESS 3%�� � dy� �� CITY _- '� e _TELEPHONE 3 3 r��v�
<br />HEREBY APPIIES FOR PERMISS�ON TO
<br />ATTHE FOLIOWING LOCATION
<br />Attach five (5) copies of preliminaiy plans for proposed work. Draw to scale and show the following as applicable:
<br />' 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:
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<br />` Topographic changes requiring cuts and filis
<br />otfier thar, normal foundation.
<br />` On•site drainage sysiems when required.
<br />' Erosion control methods when required.
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<br />C...J'C �1tC=E � : i ,� C � �
<br />�� FOR CONSTRUCI'ION ATE
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<br />AP ROVED AS CONS UCTE� 1�DATE
<br />PERMIT IS VALIU FUR 1'YEAR
<br />EXPIRATION
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<br />The untlersignetl owner hereby agrees to hold anA seve harmless
<br />Ihe City ot Everetl nom any ano an cleims lor Uemeges, co61s,
<br />expensrs, or cause> ol action ihat may arise bnca�so of instellation
<br />antl mainlenance ol the improvement or other righ4obwey uae
<br />�creto applied tor antl lurther agrees to remove same upon notice
<br />Irom the City anC to replace public pro0erty Camaged ihereEy.
<br />EM
<br />POST pN � CALL �gfi INSPECTIC�N
<br />259•8811
<br />J06SITE 24 HRS. BEFOREC(.+..+CRUCTION
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