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<br /> � �'""` � tl APPLICATION FOR PUBLIC WORKS PERMIT ;
<br /> Type or pdnt cleedy with ink �
<br /> I PRESS HARD-YOU ARE MAKING COPIES � a S I
<br /> PERMIT NO.
<br /> I PUBLIC WORKS i �
<br /> EVERETT,WASHINGTON ' '
<br /> i ,1 .`} , ' BLDG. DEPT. NO. �
<br /> ❑ OWNER �AGENT DATE �
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<br /> � APPLICANT/FIRM REPRESENTED _ �' �� �' � �'f.�'
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<br /> ADDRESS - � �I'`C.. CITY -.-t%"`E-L TELEPHONE ` U�I '- � I
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<br /> I HEREBI'APPLIES FOR PERMISSION TO -��� -(i
<br /> � 4�, a , 1 ,4 p ; ., .� � . i
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<br /> ; AT THE FOLLOWING LOCATION ' � � -� j � �- i � ' �� r
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<br /> � Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicabie:
<br /> Ij ' 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. " Norih arrow
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<br /> ' � . SlgnaWreolApplicenll� ,
<br /> ' PUBLIC WORKS PERMIT
<br /> CONDITIONS:
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<br /> ,' . . . 1. (`��:`J(J+)ra\ �S �.�� ..o.�:j� �,c -\�..... tit. .�t-..v �Q (C.� f O�iv� �l , :
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<br /> i �. � � �... . � . . . � . . . . . The undersigned owner hereby agrees lo holtl antl save harmless �
<br /> , . . . . . . . . . . �. . . Ihe City ol Everett rrom nny una au claims br demages, cosis,
<br /> '� � . . . . . . . . . expenses,or causes ol action ihat may erise because ol Instelletion �
<br /> '� � - �� � • � � • � � � � and maintenence ol �he Improvemant or other righPohway use �
<br /> � - � � � � harelo applietl lor enA further agrees to remove same upon no�ice �
<br /> �� ' � trom Ihe City antl to replace public pmperty damaged Ihereby.
<br /> � �---�:- %�:��-- �-d>-� 8 z_ I' ..,_(
<br /> I p pN/C�D/JF? '. ONSTRUCTION DATE ACKNOWLEDGEM�NT OF CONDITIONS ��,
<br /> � �F'i��D � � ; -' . . . , . , . -� ,
<br /> (P — /O� �_ / � ; ,.. '! ' , : ' : /. - ': ,�
<br /> � R VED AS N RO D DATE SIGNATURE OF APPLICANT DATE �
<br /> ' PERMIT IS VALI FOR 1 YEAR pOST ON CALL FOR INSPECTION I
<br /> 259•8811 i
<br /> ' EXPIRATION JOBSITE 2qHRS. BEFORECONSS'RUCTION
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