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! e"°'e" APPLICATION FOR PUBUC WORKS PERMIT <br />I� Typo or print cleerly Wi�h Ink _� 2 > .q <br />� � PRESS HARD - YOU ARE MAKING COPIES pERM1T NO. —7 <br />PUBLIC WORKS <br />EVERETf, WASHINGTO�J � �, �.., BLDG. DEPT. NO� ��� �! <br />❑ OWNER ❑ AGEN i DATE = __- �_ _� � _�—_ _ <br />�� � -r / <br />APPLI('1NT/FIRMREPRESENTED -_ _�r���r_s__r`-=»Sr' _ <br />ADDRESS -� � ^-z �- `^� � �' � c CITY ! � �'E �F! '� l TELEPHONE � j 7-� ��v�� <br />HEREBY APPLIES FOR PERMISSION TO L�� -� �!� .� �� ���`����`�T� <br />,. ` f% ' � <br />ATTHE FOLLOWING LOCATION _7'`J i � % � %L_ .1�CiCi�-i f%�� /�l/t� ti- ✓�''rr'��'i ���G'� <br />7— <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 />P'UBLI <br />CONDITIONS: <br />:.. <br />(---� - - , .. . . . . . . . . _ . . <br />�......j. <br />._._ .._.._ r .. . . . . . . . . . . . . <br />�_: . : . . � . . � , <br />_..�....j.... .: ... <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />" On-site drainage systems when required. <br />' Erosion con:rol,methods wher required. <br />' North arrow .�� / ,' <br />f, <--�� � / /�,��L�� <br />`� �-�- � - - � l- ,� ' - <br />- 3ignawre o� p can <br />PERMIT <br />, . i ! . <br />� � _. _.� �/ " . " . �' �' <br />' ( �`.,,�'. -:.��'��__. � - <br />PERMIT IS VALID <br />i_; EXPIRATION <br />1 YEAR <br />Thc undersigned ownen c�reby agrecs to hold and savo harmless <br />the Cily ol Everell iwm any ana an claim� lor damages, cosis, <br />:xpens�s, or causes of action that moy arise 6eceuse oi installation <br />and ma�n�enance of 1ho improvement or olher right�ol�wey use <br />herclo applied lor anA lurthei egrees to remove same upor notice <br />Iwm the City and to repl;ice public pmperty damaged 1 iereby. <br />NT OF GONDIT�ONS <br />.�' .� <br />% � <br />POST ON I CALL FOR INSPECTIOI i <br />259-8811 <br />JOBSITE 24 HRS. BEFORECONSTRUCTION <br />V <br />