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everett APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. _ <br />PUBLIC WORKS <br />EVERETT, WASHINGTON of { -_ BLDG. DEPT. NO. <br />,OWNER ❑ AGENT DATE <br />APPLICANT/FIRM REPRESENTED _2ST L I—ir� �IGSuh <br />ADDRESS �S� `� V ` `,r "^� CITY 'v< r< _TELEPHONE a .5 <br />HEREBY APPLIES FOR PERMISSION TO 9i l d <br />[)ii i ), L 13 yy77< L I'� Cl � 1 Y, g'. �rC. <br />AT THE FOLLOWING LOCATION /5 all I%i Y�' <br />Attach five (5) copies of preliminary plans for proposed wcrk. 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. (N7 <br />jrthL7,,,` to of Applicant <br />PUBLIC WORKS PERMIT <br />CONDITICNS: <br />IThe undersigned owner hereby agrees to hold and save harmless <br />the Lily of Everett from any end all claims for uamages, casts, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-of-way use <br />hereto applied lot and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />i <br />APPROVE I.ONSTRUCTION DAT ACKNOWLEDGEMENT Or CONDITIONS <br />S $� <br />AP OWED AS CO T TED DA E SIGNATURE OF APPLICANT DATE <br />PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br />I-POST <br />ON 259-8811 <br />EXPIRATION _ JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />