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r-_� '— _ _ .. . <br />�everett APPLICATION FOR PUBLIC WORKS PERMIT <br />TYPB Or Print clearly with ink <br />PRESS HARD • YOU ARE MAKING CUPIES <� <br />PERMIT NO. '� 1 ���� �-- <br />PUBLIC WORKS — <br />EVERETT, WASHINGTON / / <br />❑ OWNER �AGENT DATE L�/� C"�' BLDG. DEPT. NO. <br />/ <br />APPLICANT/FIRM REPRESENTED %�- r✓.� 7/ `� -/: -.� �7.'r/- _ j�` <br />. <br />ADDRESS �C' /:n } �1 [7,�' CITY �i-�r, � 7�%TELEPHONE ? `�%' - %�� � ��� <br />HEREBY APPLIES FOR PERMISSION TO � <br />1°... .. T_ ! �'7 �. <br />ATTHE FOLLOWING LOCATION _ �//C� /��.. �i:.- � <br />C ' <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. t 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 control methods when required. <br />' Centerline of abutting right of way. ` North arrow _ <br />CONDITIONS: <br />. .(, .. .. <br />. , ; . : �c'.r . �,g � ro �r.�� P�a,.� .s " <br />�11 <br />: ; : : �c� u � ir �G `�� 7/Y 2__: : . . : : : : . ; <br />� �.. . <br />, . . . ;. _t �:_ j�; �. <br />:'.:.�::. :- ::�..::, . �::: : � :�: :. :' .;" .':. � <br />; t. , <br />. � ,, ; G : . � t- : �. <br />� �.: _. . , � : ,. , : <br />r , <br />; . . , , , �. �.; <br />, i ._._.._ � . —_____ �. , __ � � ._ , . t' . ;. . + <br />i-,.i ; I , . . , ,.......,...�.. ...� ..1. � �,� <br />. �.. i .! .� . i�..... <br />i , <br />• : . . . T ^-� . . . f . : , ,,. `_ . . . . . . . . <br />. ...�...�.... <br />� � � • • • ~ ` � • . � � . T�e undersigned owner hereby agrees lo hold and save �ermless <br />�• i�-� 1•� � � the Ciry ol Everell trom any ana eu cialms lor damages, cosis, <br />- • � � � . � � � � � � � � eMpenses, or causes at action �hat may arise because ol instelletlon <br />' ' - ' - ' ' ' ' ' - � � - - � � � antl meinlenance ol the improvemanl or olher righPo4way usa <br />-�_� � hereto apolied lor end lurt�er agrees to remove same upon notice <br />� �'- ' � from Ihe Cily end to replace public property damaBeC iharaby. <br />�-'�7 1 <br />%��1�� � % -,!� ; - <br />' iv <br />� DA' <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />ACKNOJJLEDGEMENT OF CON iTIONS <br />i / <br />/ ? v �� J - . <br />/ -��/'i�. " ..;.N_� _ � �:.�� / _� • ' <br />� �_� ! �i <br />SV6NA UREOFAPPL A DATE � <br />POST ON I CALL FOR INSPECTION <br />JOBSITE 259-8811 <br />24 HRS. BEFORE CONSTRUCTION <br />� 'i <br />