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"'�`�" APPLICATIC�N FOR PUBLIC WORKS PERMIT <br />� TYDe or Odnt dearlY with Ink <br />PRESS HARD - YOU ARE MAKING COPIES �� � s� <br />PUBLIC WORKS PERMIT NO. <br />EVERETT. WASHINGTON BLDG. DEP7. NO. �'2' ��s%�v <br />❑ OWNER ❑ AGENT DATE _ � ' `f �s- <br />APPLICANT/FIRM REPRESENTED t �I , � r —C� <br />ADDRESS ��� Sh0lt K� CITY F-/� rrr�-�TELEPHONE_33`%G/�C'g <br />HEREBY APPLIES FOR PERMISSION TO ex i 5T � nJG �r2� r/E oJ�i `J <br />AT THE FOLLOWING LOCATION <br />i le <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. • rosi contr I-m�tho s when required. <br />' Centerline of abutting right of way. ` North rro <br />�^— <br />igneture oi Ap011cent <br />PUBLI� WORKS PERMIi <br />CONDITIONS: __. <br />j.... <br />, . . . . . . . .1. C�Y 4e� � �-. � S . . ���. . . .�.lS �. � ���. �-� 1 .f N . <br />c� 1` � v c�>��, n �� ... .�. . <br />� . . , . . . . ' � l. - . . ` . _ ` . F� . <br />�'�L�'C'�"� t , �" <�?<I J-1'` I N 1 C'..•... — \ S . Vti 1 ' . <br />� ... . . . . �1 �� � C t �li_'.ye��"l,l(Je. .1.�.�'li�li\ . .�lnbllt. . . . <br />L.�_ . _ _ .�J-!lClPic.c . t7.�� . . . . . . _.. . . . . <br />�... . i <br />i . ; ' ; . WC��-�cs "`�: .-:•�� �.�-�cr i�S CP<� �l�f c'� _' f'�Gf` ; . <br />,. .��1. _ _ , _� . - . . <br />. . . , . , � �'>�,c�`c'\ lv.( IUvG;'� , . <br />i . . . . � . . . . . . . . � . . . . . . . . . . . . <br />. . <br />I� � � . . . . . . . . . . . . , . . . . . . . . <br />' --- � : : ._: _ . : . . . . . . . . . . . . . . . . . . . . . . . __r.�- . __ . <br />;.: ,i :': � �'a—._-_{— ..: ::. ;: :;': � !: <br />.� �-� -��. .-r --- , r .-� - . . . <br />,. . .. :, � <br />�. �. , <br />�_� ^� �;,, f,,, ,,, , The undersignetl owner hereby agrees �o hold and save harmless <br />� , , � 1 , :. � , , , , , . : I � . �. , . . the City ol Everett from eny ena a11 clelms lor damape4 cost& <br />' expenses, or causes ol eclion Ihal may erise Decause ol installation <br />i . . . . . . . . . . . . . <br />, . . ... . . . .. . . . . . . . . . . _ �. . . - � . � nnd maintenonce ol �he Improvement or other riphhol�way use <br />�. r��. 7 � �� .N � . . . <br />PERMIT IS VALI <br />EXPIRATION <br />�� <br />' )/4'�/c�Z <br />hereto applied for and iwther agrees to remove seme upon nolice <br />Irom the Cily end �o replece public property damaged ihereby. <br />.�� <br />CKNO L GEMENT OF D�TIONS <br />= J' / �.3 <br />SI NATUREOFAPPLICANT OAT <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSfTE 24HRS.BEFORECONSTRUCTION <br />