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e"°rctt pppLICATION FOR PUBLiC WORKS PERMIT
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<br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO.
<br />PUBLIC WORKS BLDG. DEPT. NO. 82/11216
<br />EVERETT, WASHINGTON
<br />❑ OWNER X'XAGENT DATE 11�.5/_82__ _--
<br />APPLICANT/FIRM REPRESENTED __ LSLTy_HO_ZeT18I1 _ ------
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<br />ADDRESS �33Z1�1t1k1LteQ�1V_d CITY EY�T_C_tt.__TELEPHONE
<br />HEREBY APPLIES FOR PERMISSION TO _�\d�4 �-t0-eXlS-tl11g-1C1tchEn
<br />AT THE FOLLOWING LOCATION .-_1332 _hlllkllte9-BlV_d—_-- -
<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 />' Centerline of abutting right of way.
<br />CONDITIONS:
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<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 />• North arrow
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<br />Si}nature of Aoplicanl
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<br />'-� The undersigned owner here6y agrees to hold a�d savn hermless
<br />Iho Cily ol Everolt �rom ony ena ali claims lor demeqes, Coats,
<br />ex0enses. or causes o� aclion Ihet may erise because ot i�elalletlon
<br />end mainlenence ol ��e imProveme�� ot other rip�4obway uee
<br />herelo applied lor and furt�ei ag�eec �o remove same upo� �oUce
<br />� / / Irom t�e Cily and to repleoa public p�oDe�y damaged, theroby.
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<br />AS
<br />(-I�' �g3
<br />DATE
<br />PERMIT IS VALtD FOR 1 YEAR
<br />EXPIRATION
<br />1.�.! ,i�Q�_
<br />CALL FOR INSPECTION
<br />POST ON 259•8811
<br />JOBSITE 24 HRS. BEFORECONSTRUCTION
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