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eV� APPLICAI�ION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES �� S <br />PUBLIC WORKS PERMIT �U. <br />EVERETT, WASHING70N <br />�OWNER ❑ AGENT DATE`2 � � �^ � � �' __ BLDG. DEPT. NO. <br />_%� _ <br />APPLICANT/FIRM REPRESENTED ____I1L�/__L______C___ __I C` �.. ! �J _ <br />� — �7�— <br />s.....�_-_L�. r � \ :�! /'- .a ,� C ) � <br />ADDRESS 't- CITY ---!'c YC L L TELEPHONE -- -=� � <br />, i � � . <br />HEREBY APPLIES FOR PERMISSION TO � <br />�/��d Ji1 i4� �1l/Ll�l� � �/�Lf.� /Yfli / n�i �i //�X . �l n. � . Qi,..: <br />U -� (I -'� �•'- ! �+ <br />AT THE FOLLOWING LOCATION _.��5 / l__Ly17 � . , � � /�%'/"C.:'!_ L <br />Attach five (5) copies of preliminary plans for proposed work, Draw to scale and show the following as applicable: <br />' Property lines and sireet identity. ' Topographic changes requiring cuts and fill� <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 cont�ol methods when required. <br />* Centerline of abutting right oi way. * North arrow <br />-i , � <br />-- ��--/ r-�{'' — <br />Signaturc ol Applicant <br />PUBLIC WORKS PER�VIIT <br />CONDITIONS: ______ ,y <br />� . �. <br />. , . L . .-.. . _ . . . . . . . . . <br />. �. I�\. ,. . � _ . . . , . . . . . <br />� _ . . . . � . . . . . . . . . . . . . <br />� � <br />. . . .7__�.__..._- .,.... ___. __ . -___._....—'_' '.. . <br />� _ _ _. . _ <br />� . ' <br />� . . <br />�::_ r��1u. t� � - y�" <br />�: <br />�1��,.-�� .4�'��--�'__� • �? � - �1 <br />� <br />l'� <br />1., � "�. <br />The unticrsignetl owncn c��ehy agrees lo hold antl save harmless � <br />tha City rl Evcrett imm any antl all cialms for damages, eosis, � <br />e�penses, or causes ol aclion thal may arise because ol installolion <br />antl mainlonance of �he improvement or ot�er �i0hPo4way use � <br />hereto upptied lor antl lur6�er agrees lo remove same upon nolice . <br />Irom the City ana to replace pu6lic property damaged Ihereby. i <br />AC;KNOWLEDuEMENT OF CONDITIONS <br />, i - �' - - <br />:,, l koe _ <br />PE�iMlT IS VALID FOR 1 YEAR <br />Pt.ST ON <br />EXPIRA: �ION ' � � � � - � 3 JOBSITE <br />�ALL FOR INSPECTION <br />259-8811 <br />24 HRS. BEFORE CONSTRUCTION , <br />_ _a, <br />