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everett pppLIC.4Z JN FOR PUBLIC WOF...S <br />� TYPe oi Print CleaAy with ink <br />i`RESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />P�RMIT <br />PERMIT NO. <br />EVERETT, N!ASHING70N BLDG. DEPT. NO. d=d. � D rYG�J <br />❑ OWNFR �IAGENT DATE __9_/l___ ._ //�-�^'- -Wy���3 � <br />� I „'f'/✓. 1 U nl <br />APPLICANTl�IRAA REPRESENTED . .. _ � 7 -O <br />7`N£�Fs'.v_47.[tsT---- -- -- - -- --- - � a3 8oy <br />�_ <br />ADDRESS �S'_'/�__G9.Q�CttC—_2_IQt7—_— _ — —_CITY E.V--fz�l-�I�-�TELEPHONE -�.f3 - G <br />IiEREBY APPLIES FGR PERMISSION 70 _CQ�t1Sjx'//�% `S%a*�'-!76�_S/l`�f� <br />ATTHE FOLLOWING LOCATIOM _I.�� l.��L�FQ_ _R�D.� ��L�� <br />Attach iive (5) copies of preliminary plans tur proposed work. Draw to scale a�d show ihe foliowing 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: <br />PUBLI <br />APPFOVED FOR CONSTRUCTION DATE <br />�' <br />� <br />• Topogra�hic changes requiriny cuts anc fills <br />other than normal foundation. <br />' On-site drainage systems when requirad. <br />` Erosion control methods when required. <br />` North arrcw . ,1 <br />pE <br />.���� `� L;� , <br />e � <br />The undersi9ned owner hereby �grees to holtl and save hermless <br />Ihe City ol Everett trom any ano au r.laims lor damages, cosls, <br />exPenses, or causes of action that may arise Decause of installation <br />and mainienance of Ihe improvement or other righ4obwey use <br />herelo applied lor and lur,her agrees to remove same upon nnlice <br />Irom the City antl to replacz public proparty tlamaged theroby. <br />ACKNOWLED3EMENT OF CONDITIONS <br />APPROVED AS CONSTRUCTED DATE SIGN/.TURE OF APPLICANT DATE <br />PERMIT IS VALID �OR 1 YEAR CALL FOR INSPECTION <br />Pr,ST ON 259-8811 <br />EXPIRATION _ I JOBSITE 24HRS.BEFORECONSI'RUCTION <br />f <br />-' <br />a <br />