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evecett <br />e <br />APPLICATION FUR PUBLIG WORKS PERMIT <br />Typa or prinl cteady with ink �„ ,U� — <br />PRESS HARD - YOU A(tE MAKING COPIES pERMIT NO. °� <br />PUBLIC WORKS <br />EVERETT, WASHIPIGTON / Z� S � <br />❑ OWNER ❑ AGENI DATE —C�� —�� <br />APPLICANT/FIRM REPRESENTED __ - <br />ADDRESS �Z��_ �'�'�L�d B�� CITY <br />BLDG. DEPT <br />��TELEPHONE �2�SS2" <br />HEREBY APPLIES FOR PERMISSION TO �� ��E�� �rw� �,r��uCT <br />. <br />AT THE FOLLOWING LOCATION �'-"' <br />Attach five (5) copies of prelimi-_n- I�s <br />A�o ' /Y'i. <br />! �7 GiJ. Mu,t� / <br />propos?d work. Draw to <br />" Property lines and street identity. <br />* Outline and dimensions of existing and <br />proposed structures. <br />' Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />f3 <br />PERMIT IS VALID FOR 1 1'EAR <br />EXPIRP:i"lON "�-7� � <br />� Z— <br />e following as applicable: <br />" Topogra�hic changes requiring cuts and fills <br />other than normal foundation. <br />• On-site drainage systems when required. <br />� Erosion c rol rnethods when required. <br />' Nort ow /A� I% v/`/`'v"'ti �_ <br />I/� <br />Signuti. �e ol Applicant <br />The undersignetl owner hereLy oqrees to holE and sava harmluss <br />Ihe City ol Evereu �rom any ano au clelm; lor demeBes, cosls, <br />expenses, or causes ol aclion Ihat may arise becausr ol ins�nllatlon <br />end ma�ntananco ol ihe improveR.qnl or olher righ��ol•way use <br />heieto applied lor and Wriher ag�ens to remo seme upon nolice <br />Irom �he C� and �o �eDlace publ�c pm�damaged}h�eby. <br />° CALL FOR INSPEc 1 w�v <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFOREC�NSTRUCTION <br />