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� APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or Drint cleerly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON �-7 � BLDG. DEPT. NO. <br />❑ OWNER ❑ AGENT DATE _��� <br />APPLICANT/FIRM REPRESENTED <br />ADDRESS ���� <br />HEREBY APPLIES FOfi PERMISSION TO <br />� <br />AT THE FOLLOWING LOCATION <br />� —� 7 6_icl <br />�/^ � —i- /. . <br />i.� 1 i,. � .. .e.� t. <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. <br />' Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Oentenlne ot abutting rlgnt nt way. <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />* On-site drainage systems when required. <br />' Erosion control methods when required. <br />' Nonh errow �' y— ,_r., <br />RKS <br />CONDITIONS: <br />� � . . . . , . �/ _G� . C" ,l��d✓ C �t '� l!/// S <br />� <br />�_.�` ,_. �-}_._..__� . . . , <br />� <br />�.:_._. ?_._�. _�. . . . . . . . . . � . . . 1 . . . . <br />j...... ; ... ... <br />i.... . � �4..... . <br />�-. ._.. � :. --_.. ----... <br />..... . .., :._ <br />�.... <br />�_ <br />,..., <br />! . . . , <br />I. . <br />'i'f � ���.� � // ` /J�l � <br />AP E� FO�� R CbNSTRUCTION - DAT <br />APPROVED AS CONSTRUCTED DATE <br />i. ... <br />. ; . . � ` !. 1 . . . � . : <br />. � ' <br />The undersigned owner here6y agrees to hold antl seve harmlett <br />the Ciry o� Everett rrom any ana an cWms lor demepee, cosh, <br />expenses, or causes oi actlon ihat may erina becaune ol inet�l4tbn <br />antl maintenence of ihe improvement or other riqht-ol�way u�s <br />hereto applied lor antl �urfher egreae to remova eeme upon nolks <br />�rom ihe City anC to replece public property Oameped theroby. <br />ACKN()'NLEOGEMENT OF ONDITIONS <br />l�vfiCZL'/�l�C � y-+iJi <br />PERMIT IS VALID FOR 1 YEAR <br />POST ON <br />EXPIRATION 7/�� /� z— JOBSITE <br />� <br />CALL FOR INSPECTION � <br />259-8811 <br />24HRS.BEFORECONSTRUCTION � <br />� <br />J <br />