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everett APPLICAT'ION FOR PUBLIC WORKS PERMIT <br /> � TYPe Or Ptin�tleatlY wilh ink � _ /� I 1 <br /> FRESS HARD•YOU ARF MAKING COPIES pERMIT NO. � <br /> PUBLIC WORKS i <br /> EVERETT,WASHIIa3TON r.� +� BLDG. DEPT. NO. <br /> CJ OWNF.R O AGENT DATE _ . /-/�/�-_�'�Y <br /> n '� <br /> APPLICANT/FIRMREPRESENTED .`��L-.r���£-�-- ����___l�.UL.1__/�L��=_ __ __ __ <br /> ` '�< � � <br /> L � "� Iv. � � �C. i Sl� CITY C �''`' � ��TELEPHONE � S ZC <br /> ADDRESS _ ��L_��--1-�t-�--. <br /> _"� CL« I G--��l���-��� <br /> HEREBY APPLIES FOR PERMISSION TO . � <br /> AT THE�FOLLOWING LOCATION �-�_�_. _`�<���`J��—L-'n`��`'�"1'-- <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and shuw ihe following as applicable: <br /> ' Property lines and street identity. ' Topographic changes requiring culs and tills <br /> * Outline and dirr�ensions of existing and olher than normal foundation. <br /> proposed structures. • On-site drainage systems when required. <br /> ` Existina and proposed utilities. ` Erosion control methods when required. <br /> • Centerline ot abutting right of way. • North arrow � � <br /> . ` � <br /> � :'\ f���-i: �� \� '� , �` <br /> F� <br /> � � SignaWreof, Ppliwnt / � <br /> , pUBLiC VNOR�ER IT <br /> COnDITIONS: <br /> , I �,� <br /> (;�,. <br /> , ` , � � I� �. <br /> � �i�� ��� � � � � �� � <br /> � � : (� 1�� � e,� l�� - . �. �� r. <br /> � _,,� � ` �{ 5 �� � '���� ���� u <br /> � � � u �� � <br /> j ��;� � �� �, � ������� ., � � � � , <br /> ,/ � �, � C�� � �\� �o- �; � P� <br /> � . �� ' � ��� � ��, � . � <br /> ; - <br /> � � � � `n ��� �� <br /> � @The undcrsi9netl ownen c�reby a0rees tc hold,nd save hermless <br /> Ine Cuy of Everett trom any ana au ciabns lor damn0es, cosls. <br /> c•pe�ses,or causes ol aclion Ihel mey xris�boceu5e ol inalellallon <br /> antl maintonance o� ��e improvernent or ot�er rig�Pol�wey use <br /> herelo ap0lied lor an�lurther nFrees�o remove samn upon nolice <br /> Irom t�e City a�C to re0�ace pu�lic pmperty tlameqxd themCy. <br /> APNROVED FOR CONSTRUCTION DATE ACKNOWLEDGEMENT OF CONDITIONS <br /> APPROVEDASCONSTRUCTED UATE SIGIJATUREOFAPPLICANT DAIE <br /> PERAAIT IS VALID FOR 1 'rEAR CALL FOR INSPECTION <br /> POST ON 259-9811 <br /> EXPIR��.TION JOBSITE � 24HRS. BEFORECONSTRUCTION <br />