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f <br />""` APPLICAPJN FOR PUBLIC WOK- A PERMIT <br />e Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />PERMIT NO. <br />EVERETT. WASHINGTON <br />❑ OWNER <br />3 /U / L <br />BLDG. DEPT. NO. Vj 3/ i <br />L AGENT DATE <br />G <br />APPLICANT/FIRM REPRESENTED <br />_ "� <br />�L))l.) 4 ? <br />ADDRESS i:.! `'I - <br />D2 1 C <br />CITY Lnr�__TELEPHONE <br />HEREBY APPLIES FOR PERMISSION <br />TO /1b F <br />V I <br />v <br />AT THE FOLLOWING LOCATION <br />FalU1 — j`I <br />L=_C1 IUf1 �tY�(.1 <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. • Topographic 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 contt'ol methods when required. <br />• Centerline of abutting right of way. ' North arrow <br />t4- <br />PUBLIC WORKS PERMIT - 1"7- <br />CONDITIONS: <br />�ii//Jr-y r .c �vfJ.•� c` r�.�. 7, /'� �c ir.Ll� '��'C 5�<%. -. -� . <br />.p,�;%� . =7�^r" r.:.J-,C'c c � lVf�,!'Pcr,„i►�Gc9ct iy �, Ji�r�i.)ce— c t- r.-<,.- I <br />��-/°r %`r r /i;C��. ,.:,�- rr "f.0� j� .S'.CO Ft ✓f74-t`' .,YG. ; ..'�/ir%�C- G� - . -< <br />C"U' C�lci�� Ciiif� �y ej n: 1i1,.pt <br />r <br />Cl i — r!1L L <br />} <br />L�, �� ..� %�� C �G y i.�, r�� //c •iJ/Q. /.v �c.'YV.i i/�C'( T. _ . <br />1%=`:.J <br />Q�y , f/The undersigned owner hereby agrees to hold and save harmless <br />O� the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />(<<"`.� -r in2J•T �� �_ and maintenance of the improvement or other tight -of -way use <br />41 <br />hereto applied for and further agrees to remove same upon notice <br />/f�`�Z from the City and to a lace public p properly damaged thereby. <br />APPROVED FOR CONSTRUCTION DATE ACKNOWLEDGEMENT OF CONDITIONS <br />r <br />APPROVED AS CONSTRUCTED DATE SIGNATURE OF APPLICANY - DATE <br />PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br />POST ON 259.8811 <br />EXPIRATION JOESITE 24 HRS. BEFORE CONSTRUCTION <br />