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0 <br />� ° � I� � �� � ,1� �� <br />e°e`"" APPi.iCATION FOR PU�IyC `JVOR1�K ERMIT <br />� � <br />Typeorprinlclearlywithjipl� Q � �7C1� <br />PRESS HARD - YOU ARE M.OKING :OPIES �a I U <br />PUBLIC WORKS ..__......__........_____.. . .. <br />PERAIIT NO.�� _ <br />— � —_ Put� ;; �, _, T .2� O 7 �. <br />EVERETT, WASHINGTON CITY O� E���R� �� �' <br />BLDG. DEPT. NO._�� <br />�7 OWNER ❑ AGENT DATE Z'.�—_��� � `' '�" '- <br />APPUCANT/FIRM REPRESENTED ���F ✓� _�1�� � "S. _ . .—_ . __ _ — ___ _ . _. <br />ADDRESS ��3 .���c��'���1� — _CITY �C.(,�!'�7�f TELEPHONE.,7S.;1 -.JGfG <br />HEREBti APPLIES FOR PERMISSION TO _._,��1�/�O 1J -T '%%C- '�n L�S �; A/�r�� <br />--cLC C_f�, `; <br />AT THE FOLLOWING LOCATION �n�j �iL'�-4CCL_�? _f1�Ii� l�/it/ <br />Attach tive (5) copies of preliniinary plans for proposed work. Draw to scale and show the foliowing as applicable: <br />c <br />' Property lines and street identity. � Topographic changes requiring cuts and fills <br />` Outline and dimensions o( existing and other than normal foundation. <br />proposed structures. • On-site drainage systems when required. <br />' Existing and proposed utilities. ' Erosion controf inethods when required. <br />' Centerline of abutting right of way. ` North arrow <br />•✓�'�'=—" a�—' �% .2 .� <br />� SignaWr Appbwnt <br />PUBLIC WORKS PERMiT <br />'����s��'���� <br />. <br />_���� ; .��/� ..� <br />� ����. •� .' . � �i�I GMJ�� <br />;�.... ' ����� <br />�...�. <br />� <br />� <br />� �„ <br />PERMIT IS VAL.OD FOR 1 YEAR <br />EXPIRATIORI <br />� +-- �� �:� <br />.; <br />� _ : � ,. �_.: <br />. ,-+ � ,-. <br />_, � <br />__. .. _ ,-; <br />-� � ._ : . �._. . � : - � - �- }_ - � _: <br />_ i_ <br />Thc untlersigned owner hereby agrees lo hold and save harmlP.ss <br />the City of Everett irom any ana aii clalms lor demages, costs, <br />espenses, or causos ol er.tion Ihnt may arise because ol installation <br />antl mainlenance oi Ihe improvemen( or other righl�ol-way use <br />herele applied lor and turther agrees to remove same upon notice <br />Irom the Cily antl lo replaCe publiC pmporty dameretl Iheroby. <br />( > <br />�— P.CKNOWLEOGEMENT OF CO DITIONS <br />�Z .� --��� ' y <br />�� �. � _�� <br />-'SI:�NATU��EOFAPPLICANT DA E <br />CALL FUR INSPECTION <br />P05T OtJ I 259-8811 <br />JOBSITI. y4HRS.BEFORECONSTRUCTION <br />