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<br /> i `w APPLICATION FOR PUBLIC WORKS PERMIT
<br /> 1 Type or print clearly wi��ink
<br /> l � PRESS HAfiD-YOU ARE MAKING COPIES
<br /> ! PUBLIC WORKS PERMIT NO.Y -Z 3
<br /> � EVERETT,WAS�GTON BLDG. DEPT. NO. —
<br /> � ❑ OWNER AGENT DATE __L�-� -� Z-- I
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<br /> j APPLICANT/FIRMREPRESENTED �Lu�'�^�'�_ �J�S'�.__✓��� ��Ir� �4-I( 'n �S�C ,
<br /> } ADDRESS � 7lJ ,F ,L' (iCk P• PI��'2 CITY F ✓ T• TELEPHONE jSr-/// L_.
<br /> � HEREBY APPLIES FOR PERMISSION TO ��1�� �� y /Ct/i�J E' C_r% �'t ���/JC( C'I/
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<br /> j ATTHE FOLLOWING LOCATIOPi I �� 'Y � ��C,CP" <���N�
<br /> IAttach five(5)copies of preliminary plans for proposed work. Draw to scale and show the following as applicable:
<br /> • Property lines and street identity. t Topographic changes requiring cuts and filis
<br /> ' Outline and dimensions of existing and other than nonnal foundation.
<br /> proposed structures. � On-site drainage systems when required.
<br /> • Existing and proposed utilities. � Erosion control me ods when required.
<br /> ` Centerline of abutting right of way. • Northarro
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<br /> SlBneture of Applicanl
<br /> coNoirioNs: PUBLIC W4RKS ERMIT
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<br /> � r _-!._. i I 1..J. �..il t . ..I . ! � ' The untlersigned owner hereby agrees lo hold end sava �armlese
<br /> ' � � r � '� r �-_ . Ihe City ol Eve�ett trom eny ana au cieims for dam�pe4 co�t0.
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<br /> � j-�-�-{-� i ��-� ��� expenses,or cause�ol ac�ion that may arise bacauee ot In��ellatlon
<br /> '----'�-�� •� r— � ��-' end mainlenance ol I�e improvement or ot�er nph4obw�y uae
<br /> � � � - hereto applieC br and Iwther agrees Io remove a�me upon notke
<br /> � Imm Ihe City end to replace public pmperty tlem�peE Ihereby.
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<br /> �A�B OV(E[��FOR CONSTRUCTION � DA E ACKNOWL DGEi�j.NT OF C DITIQNS� ��
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<br /> AP OVED A CONSTR ED � DATE SIGNA RE OFAPPLICA 7 DATE
<br /> PERMIT IS VALID FOR 1 YEAR pOST � CALL FOR INSPECTION
<br /> 259-8811
<br /> EXPIRATION � JOBSITE 24HRS. BEFORECONSTRUCTION
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