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i <br />� <br /> everett pppLICATION FOR PUBLIC WORKS PERMIT <br /> e TYGB or Pfinl Clearly Wi�h ink p <br /> PRESS HARD-YOU ARE MAKING COPIES pER'vIIT NO. o`� � <br /> PUBLIC WORKS � <br /> EVERETT,WASHINGTON BLDG. DEPT. NO..�����'�S <br /> }�] OWNER ❑ AGENT DATE ,��.��� <br /> APPLICANT/FIRM REPRESENTED _�n SCh �� �/Ly -- <br /> ADDRESS _�L!_7���'rnf� CITY �-�����E7T TELEPHONE����� ���5- <br /> HEREBY APPLIES FOR PERMISSION TO `'_�11�5I � �+C.i=�- -� A'���I� <br /> V <br /> ATTHE FOLLOWING LOCATION _f m'�1�'It <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 filis <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 oi way. ` North arrow <br /> —y� IgneWreoiAPPlicnnt <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: : _ . <br /> , . . � . . . . . . <br /> . . . . . . . . . . . . . . i . . . . . . . <br /> . . . . . . . , . , . . . . _ . <br /> � , .�.1.... .__... -.. .- - --. . . _ . . <br /> : . : .: . . . . . . . . . j_ . . . . . . . <br /> ' . : : : : . � . � : � : : : � : : : : : : � : . . : . . . . . .__:. . ' <br /> � � <br /> . . ._ . _ __. _ i ___._--- - - --+---_ - �. . _ _ _- - --— - - . . . . . _ . . _ . . _ : <br /> , . , . . : . . <br /> , : . � . . a . : . <br /> , . . . , . . . -- _ , . . . . . . ; . . . . <br /> . . : : ; � . . : � ,�1T: . : : : : I <br /> `, : : ;_:�4�.-� : ' : l : � : f : :�( : : . � <br /> ' ? ��-,_^T.._:_�._�.�_ �_;.�-- <br /> . . a } <br /> _ :_ : .---�---- —:_:_:_:_:. ` t . :-- : . <br /> y The untlersigned owner hereby ayrees to hola end seve harmless <br /> I�e City ol Everelt trom eny eno au cialms lor damoges, costa <br /> ' ' ' ' ' ' ' ' � � � � � expanses,ot causes ot action�hat mey ariso 6eceuse ol Installalion <br /> � - ' ' ' ' � � � and meinlenance ol Ihe improvement o� other right•obway usn <br /> � � � � � . . . . horeto npplied br ond furt�er ngrees lo remo�a sama uoon no�ice <br /> . . - . Irom Ihe City and ta reFlnce public p�operty Aemaged Ihuroby. , <br /> _.��i" ( .�ll��.. J �G " Y 2_ �' <br /> APP VE F N CONSTRUCTION ATE ACKNOWLEDGEMENT OF CONDITIONS <br /> - z?(D � �-�;,1�. L...� � s'-�S-�'Z- <br /> APP AS C NS CTED DATE SIGNATU�E OF APPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> PQST ON 259•8811 <br /> EXPIRATlON ' �"�-�� JOBSITE 24 HRS. BEFORE CONSTRUCTION <br /> I <br /> - - - ,�� . � <br />