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� <br />� <br />� <br />; APPLICATION FOR PUBLIC WORKS PERMIT <br />Tyve or vrint clearly with ink <br />� PRESS HARD • YOU ARE MAKING COPIES pERM1T NO. <br />JBLIC WORKS <br />:VERETf, WASHINGTON BLDG. DEPT. NO. � O <br />❑ OWNER ,�`�AGENT DATE � <br />APPUCANT/FIRMREPRESENTED �•� <br />ADDRESS <br />HEREBY APPLIES FOR PERMISSION TO <br />n� <br />I �c CITY ����r�'- TELEPHONE zS?'32�� <br />AT THE FOLLOWING LOCATION �'� -3 � ��` P <br />� <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 control methods when required. <br />• Centerline of abutting right of way. • North a ow � <br />�l/ JZ�L � �i -e'`� <br />�_� SiBnalureolAppliCant <br />PUBLIC WORKS PERMIT <br />� <br />� <br />AP�qii1GY�A6CONSTRUCTED DATE <br />�. <br />�'J_v� ��_. <br />The un signed owner �ereby aBreaS�to hold and seve hermiesa <br />the Ci y ol Everett irom any ena an cleima for Eemapa& �ost0. <br />expenses, or causes of action thet mey ariae beceuee of inatalletion <br />xnJ �neininnencn of Ihe imp�ovamanl ui o�ller tlg��-ol-wey une <br />hereto epplieA lor and further agreea to remove eame upon notice <br />lrom Ihe Cily and to replace DuDlic property EamaQed IhereDy. <br />ACKNO EDGEMENT OF ONDITI , <br />��.` � /d �- <br />SZN TUREOFAPPL ANT DAT <br />PERMIT IS VALID FOR 1 YEAR pO�T ON CALL FOR INSPECTION <br />259•8811 <br />L EXPIRATION 8S JG�BSITE 24HRS.BEFORECONSTRUCTION � <br />