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<br /> � """" APPLICATION F�CDR PUBLIC WORKS PERMIT
<br /> I � TYPe Ur Print tlearly With ink
<br /> I PRESS HARD• YOU ARE MAKINC COPIES pERMIT NO. �����b __
<br /> ' PUBLIC WORKS �
<br /> j EVERETf,WASHINGTON BLDG. DEPL MO.',-_'.��= � �
<br /> iES OWNER ❑ AGENT DATE _�i_��-�--- '
<br /> � APPLICANT/FIRM REPRESENTED ______�r`���g�7���-�- -------------- I
<br /> I ADDRESS � � � 3 RA iN/(" I � ' � � CI'fY E V�_t�� T TELEF'HONE 1S� •h S n0 �
<br /> �I HEREBY APPLIES FOR PERMISSION TO �.aD t�n r N n nM �n �X!S T��rr �
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<br /> i ATTHE FOLLOWING LOCATION ��� RAiiv/�II D�((��_ I
<br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: �
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<br /> � • Property li�es and street identity. ' Topo3raphic changes requiring cuts and fills
<br /> � • Outline and dimensions of existing and other than normal foundation.
<br /> � proposed structures. • On-site drainage systems wiien required.
<br /> I � Existing and proposed utilities. " Erosion control methods when required.
<br /> • Centerline of abutting right of way. ' North Arrow �
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<br /> � ' Signature of ADPlicant I
<br /> � PUBUC WORKS PERMIT
<br /> � CONDITIONS: I
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<br /> The unaersigned owner nereby agrees to hold end save �armlass
<br /> � ( � I } �� r y � „ j�,. ( � Ihe City of Everett trom any ena au claims for dtmeqe0. coatG
<br /> i f'��1 � � ' � 1.! eMpenses,or causes ol aclion thet may erisa becauee of Inatdlatl0n I
<br /> . . end maintanance ol t�e imD�ovement Or other nqhiroFway use I
<br /> herelo ep0lietl lor and lurlher eB�ees to iemove same upon nollca
<br /> ' / / � Irom Ihe City enE to replaca public property dama0� �hemby.
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<br /> I A V FOR CONSTRUCTION ! DA ACKNOWLEDGEMENT OqCOND TIONS "
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<br /> � � Z 8 3 -f c/ ' '����f/ �
<br /> � APPROVED AS C RUCTE D TE SIG�T�I RE SJF APPLICAN DATE
<br /> ! PERMIT IS VALID FOR t YEAR � CALL FOR INSPECTION I
<br /> POST ON 259•8811
<br /> EXPIRATION— JOBSITE 24HRS. BEFORECONSTRUCTIaN I
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