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ftm;. <br />�" APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print dearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. r'Z <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />O OWNER ❑ AGENT DATE 3 ho IS 2 SLOG. DEPT. NO. <br />APPLICANT/FIRM REPRESENTED <br />ADDRESS _1141.3.i 'qI Q2 ►JE _CITY/11Aa�SVtl�£TELEPHONE�Se'6IKI <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION �t�n`' ���0-I�� ELIEPtOc1 Wu !?9'0-OI <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. <br />Outline and dimensions of existing and <br />proposed structures. <br />Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On -site drainage systems when required. <br />• ErosioLifntrol methods when required. <br />PUBLIC WORKS PERMIT - /voT <br />CONDITIONS: �o/J�J«CTin� ynJi /L �Lfj�o��pLJ <br />�•: i�fryc�c��o.9�1c � �. r� �� /�.o �sv y�� ss_ <br />i1`��pevl�.�c�J TES � i9.�,�:��y>�fi,E'E.o ToijLc �Ay /n1 !'c KLi!/J•G. . <br />td�'i9ii>)f%G'E-' C'c,-�Jj:�vL %✓ .�',eo �G <br />cif9ik'.. �'fj%Y%�' P �.9cir.�.ei✓i,9 � /✓o�?��� Lfjnl,os'ci9Pc ; <br />.o�%/✓y CCU T <br />::vr��.J:.:s-�'�'I/r_`�� . i�J /��i�iJ �-v�� .. i9�f;��ii,�j • - <br />. <br />Cvn tr 7;<err77 C, -J 'I ,4=�/moo iriJ�E'v7�iYJr�✓7S / � <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and an claims for damages, costs, <br />C�/Ty L✓/e L. /- expenses, or causes of action that may arise because of Installation <br />and maintenance of the Improvement or other right-of-way use <br />!"T hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />p , <br />APPROVED FOR CONSTRUCTION DATE ACKNAWLEDGEMENT OF VOWDITtONS <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />POST ON CALL FOR INSPECTION <br />OPOSP259.8811 <br />T <br />ON <br />24 H RS. BEFORE CONSTRUCTION <br />