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� <br />ev"�" APPLICATION FOR PUBLIC VUORKS PERMIT <br />Type or print clearly wilh Ink <br />� PRESS HARD • YOU AfiE MAKING COPIES g.Z p� � I <br />PERMIT NO. — <br />PUdLIC WURKS <br />EVERETT, WA�NGT�N BLDG. DEPT. NO.. 775 <br />� OWNER � AGENT DATE �/L���L _ <br />APPLICANT/FIRM REPRESENTED �!I t��j�—(,._C �'—"t—��—}�Q f�l � ��� �- <br />ADDRES�/ /'✓ i�!1_C. � N d. CITY ���_ 3�ELEPHONE � 3�-36�-3 <br />HEREBY APPLIES FOR PERMISSION TO <br />ATTHE FOLLOWING LOCATION <br />7 <br />Attach five (5) copies of preliminary plans for pruposed 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 />• Existinc� and proposed utilities. <br />• Centerline of abutting righ[ of way. <br />PERMIT IS VALID'FOR 1 YEAR <br />EXPiRA�'iON <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On-situ drainage systems when required. <br />' Erosion control methods when required. <br />" North arroy✓1 , _ <br />IT <br />, � ,, <br />�� if i r_t <br />� _ �.+. _, ,_�, . <br />-�-. • . <br />ar�; -� -=-� • - f- <br />� . .�._� <br />� - �. <br />'� • -- '--• •-� -f <br />�, <br />=, <br />, — - -- •- -; <br />�,_� .�: . - . - — - <br />— ;—+— — — — — — ; -- --��— <br />..;_Y The undersignetl �owner hereby agrees lo hold and sava harmless <br />iho Ciry oi Evcrett Irom any antl all caims for damages, costs, <br />��—.- e�penses, or causes ol action Ihal may ai�se beceuse ol inSlallallon <br />end maintonance ol Ihe improvement ��r othor riph��ol�wey use <br />+— herelo applied lor antl furiher agrees to remove same upon nolice <br />—}� -' from Ihe City and to replace puDlic property damegaA lhereby. <br />y �_ <br />ACKNOWLE <br />' ' �� <br />POST ON <br />JOBSITE <br />CALL FOR INSPECTION <br />259-8811 <br />24 HRS. BEFORECONSTRUCTION <br />� <br />