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7 <br />L <br />F <br />L <br />everett APPLICATIC A FOR PUBLIC WORK PERMIT <br />© Type or print Clearly with mk —_— <br />PRESS HARDARD - -YOU ARE ARE MAKING COPIES PERMIT NO. <br />PUBLIC WORKS <br />EVERETT, WASHINGTON C: 1 BLDG. DEPT. NO._.— <br />D OWNER ❑ AGENT DATE __ - <br />APPLICANT/FIRM REPRESENTED <br />CITY TELEPHONE <br />ADDRESS - <br />HEREBY APPLIES FOR PERMISSION TO <br />()5� E�x'S�lvL 'i.Ytu�.c�rty <br />I Crye <br />AT THE FOLLOWING LOCATION <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 fills <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 of way. • North arrow <br />--- Signature of Applicant <br />PUBLIC WORKS PERM17' <br />CONDITIONS: <br />I r <br />2-11-1 <br />I <br />I <br />i 1 i <br />f 1- <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED D TE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from 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 of other nght•of-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and 10 replace public properly damaged thereby. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />-( L(.t <br />SIGNATURE OF APPLICANT DATE <br />CALL I -UK nvarca, r wr. <br />POST ON 1 259.8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />-1 <br />.1 <br />111 <br />L. <br />J <br />