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�everett � A�PPLICATION FOR I��.�BLIC WORKS PERMIY
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<br /> PRESS HARD-YOU ARE MAKING COPIES g 1 � 7
<br /> PERMIT IJO. '� 3
<br /> PUBLIC WORKS —
<br /> EVERETT,WASHINGTON BLDG. DEPT. NO.����
<br /> ❑ OWNER �AGGNT DATE _6 '_L-__�F_�___ `�
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<br /> A�PLICANT/FIRM REPRESENTED _I__ ����_ F ��G'X'!Y �_._ C�M f�•_
<br /> ADDRESS `�d �- � v S I'�• W . CITY/ I����L�o TEIEPHONE �'� '�,� S��
<br /> HEREBY APPLIES FUR PERMISSION TO bt�<<� 0_1'�-_y�� � -
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<br /> AT1HE FOLLOVJING LOCATION : ��3�y''-e ��. ��t'.�z� wA ,
<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. ` 1 opographic 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 o( way. � North arrow
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<br /> ,S�Bnal re ol Applicant
<br /> PUBLIC WORKS �ERMIT
<br /> CONGI7:nNS:
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<br /> -�-I -�� -1 - � }-•� - � t -r-.:- - .i-. ...+ • The undersigned owner hereby agrees lo hold antl save h0rmless
<br /> � � -� � �-}--�- � } { � -:_ the Ciry ol Everott rtom any and an claims lor dameqes, cosls,
<br /> 1 � aMpenses,or wuses ol ar.tion Ihel may arise bewuse ol inslalla�ion
<br /> antl maintonance of the improvement or olher right�ol�wey use
<br /> � F� '- '� - '- '`-'"'i Y!'- hcreto applied lur ani luriher agroes to remove same upon notice
<br /> � � 1 �� �- �'-- - '� �'��L :�`` Ir�m ihe Clty and to replace public property damogetl thereby.
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<br /> R FD FOR C STR�TION � A ACKNOWLEDGEMENT OF CONDITIONS ��r
<br /> :5 ��g3 .,�,���.��,� 6��- s�_
<br /> P AS STRUCTE DATE SIGNA REOFA PLICANT DATE
<br /> PERMIT I. FOR 1 YEAR pOST ON CALL FOR INSNECTION
<br /> JOBSITE 259-8811
<br /> EXPI RA' 1f3�1— — 24 HRS. BEFORE CONSTRUCTION
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