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APPLICATION FOR PUBLIC tNORKS PERMIT <br />Type or print clearly with ink X <br />PRESS HARD • YOU ARE MAKING COPIES PERMIT NO. v <br />PUBLIC WORKS C <br />EVERETT, WASHINGTON BLDG. DEPT. NO._Q_ JD� <br />®'OWNER ❑AGENT DATE <br />APPLICANT/FIRM REPRESENTED __-_—_— -- <br />ADDRESS �� ���� t —CITY r'_�— _Tr TELEPHONE <br />i, i <br />HEREBY APPLIES FOR PERT':-SION TO ili 6 <br />AT THE FOLLOWING LOCATION _j _qtJ.—%��=I%�4�� — <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 />` Topographic changes requiring cuts and fills <br />' Outline and dimensions of existing and <br />other than normal foundation. <br />proposed structures. <br />` On -site drainage systems when required. <br />• Existing and proposed utilities. <br />' Erosion control methods when required. <br />. Centerline of abutting right of way. <br />' North <br />q f/p� <br />` ' v Signature or NppI <br />coNolrloNs: PUBLIC WORKS PERMIT <br />r <br />2 <br />, eD,U). <br />M qj)u �a <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett ❑om any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of the Improvement or other right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />