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�- --- -- - --- -- ' <br />I N"`�. APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYPe or Prin� cleady with ink I <br />PRESS HARD - YOU ARE MAKING COPIES pERMIT NO. � a 3 S � <br />PUBLIC WORKS r ^ // <br />EVEREI?, WASHIN3TON � BLDG. �EPT. NO. _- �' �`�'� y <br />i [�OWNER ❑ AGENT DATE _ �- ' ��� _ . .. <br />� APPLICANT/FIRM REPRESENTED _ l��!�����'�� i �.�,.�-�,T�_-'�-h,+i � Z i�. �� <br />ADDRESS ._—_� � ' l �� CITY ��i;: r'" TELEPHONE ^.^�`�'�I �� <br />il HEREBY APPLIES FOR PER�dISSION TO __��"�-� �� '� � � � �� F , � � � - - ��, <br />� <br />�� � <br />ATTHE FOLLOWING LOCATION _�'��'� � lc�• � ��� • <br />Attach five (5) copies of preliminary plans tor 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 noimal foundation. <br />proposed structures. ' On-site drainage systems when required. <br />* Existing and proposed utilities. ` Erosion control methods when required. <br />' Centerline of abuttina right of way. ` North arrow <br />„ ,; <br />•—!_---•=: .. `;, -" <br />Slpnal�ro ol pRlGant' <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />_ ....... . . <br />�.�,. .. <br />_..... _ . . . . . . . . . . . . . . � . . . . . <br />I..-_ . : . . . . . . , � . . . . . <br />�..,_'.._ ...... ................ <br />�_-,�_ . . . . . . . . . . . . . . . . <br />'...:...,. ... <br />�.._... <br />� .:i <br />� . . . . , ' `.. . <br />� ' . /� <br />�..� % ' _�1 .ti� �._.. <br />� <br />(.i <br />; � % �- <br />G� <br />1 <br />The untlersi9ned owner hereby agrees Io hold ano save harmless <br />Iha Cily ol Everett trom any ano au claims br damxges, costs, <br />erpenses, or causes of aclion Ihat may arise because ol inslallation <br />antl malnlenance ol tho improuemenl or other riBht-ol�way use <br />hereto apPliatl !or and IurtOer aBrees ro remeve same upon notice <br />Imm �he Cily and to replece Oublic propetly tlamepetl Ihereby. <br />ACKNOWLE <br />OF CONDITIONS <br />i: <br />, _ DATI <br />PERMIT IS VALID FOR 1 YEAR - I I � CALL FOR INSPECTION <br />� POST ON 259•88t 1 <br />EXP!RATION "� ��' `y� 6 JOBSITt 24 NRS. BEFORECONSTRUCTION <br />i <br />t <br />