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<br /> � APPLICATION FOR PUBLIC WORKS PERMIT
<br /> TYVe or print clearly with ink
<br /> PRESS HARO•YOU AHE MAKING COPIES pERM1T NO. � 7 � � `--'
<br /> PUBLIC WORKS �
<br /> � - EVERETT,WASHINGTON BLDG. DtPT. N0.
<br /> 1� OWNER C] AGENT DATE �=�`1'_a�—_
<br /> APPLICANT/FIRMREPRESENTED .lOh_N�.E1MT2' --. - ---.----
<br /> ADDRESS J���- ��-� �ve S.E. cirv �E'vc%rel! TELyEPHONE 3�3����
<br /> HEREBY APPLIES FOR PEFMISSION TO �6�'J�J��/ � ��G��'�"`�' �`4�
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<br /> ATTHE FOLLOWING LOCATION _/¢�� 2� UC' • S.,E•_ , B/C I.UA.
<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 /> propased structures. • On•site drainage systems when required.
<br /> ` Existing and proposed utilities. • Erosion control methods when required.
<br /> " Cer.terline of abutting right of way. ' North arrow
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<br /> SlpnaNre ol AD�licanl
<br /> ���� �wv - � ' PUl3UC VIiORKS PERMIT
<br /> CONDITIONS:
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<br /> � �� —"-� � The undersipned owner hereby agrees to hold antl seve harmless
<br /> ' � � � ' � � � ihe City ul Everett trom any ana au cia�ms lor damapes, cosis,
<br /> � . . expenses,or causes ol action Ihal may arise beceuse ol in6lallation
<br /> . . . . . . . and main�enance o� ihe impmvemen� or othBr r10��'obwey uae
<br /> , . . . . . . . . � � herelo epplied lor and lurlher agrees�o remo�e sema upon notice
<br /> . . . . . . . . Imm 1he City and to replace public pmperty damepetl �nereby.
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<br /> _ � APPR- F ONSTRUCTION DATE ACKNO/WJLEDGEMENT OF CONDITIONS
<br /> � �P .� �O O� }� ��NS�V ���GC�'1GC S �� ���
<br /> A ASCONS UCT D DAT ATUREOFAPPLtCANT DATE
<br /> PERMIT IS VALID FOR 1 YEAR CALL FQR INSPECTION �
<br /> POST ON 259-8811 �
<br /> EXPIRATiON JOBSITE 24HRS. B�FORECONSTRUCTION _
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