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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 />EVVERETT, WASHINGTON /O BLDG. DEPT. NO. <br />47 OWNER ❑ AGENT DATE <br />APPLICANT/FIRIA REPRESENTED <br />ADDRESS /D 3/ �'eG/'lam'` CITY � Ie£ TELEPHONE r2 6r� <br />HEREBY APPLIES FOR PERMISSION TO _ �P�GNT OF <br />ATTHE FOLLOWING LOCATION _ Jy1E Z791-- <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />C <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 />• Exi:,ting and proposed utilities. ` Erosion control methods when required. <br />' Centerline of abutting right of way. =North arrow <br />a -esiy alure of Applicant <br />PUBLIC WORKS PERMIT <br />COND'Tlnnlc. LOTS %S4�lo �LdGIC 3�0 <br />I. <br />I <br />i <br />I <br />_ WTzd_ <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and an claims for damages. costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-ol-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />OF CONDIT 5 <br />4P_AROVEDASC "`!`RUCTEDI" DATE Z31UPIA I uncvr Arruv.rav r ....,.- <br />PERMIT IS VALID F((�171 R 1 YEAR CALL FOR INSPECTION <br />FJOBSITE <br />ST ON 259.8811 <br />EXPIRATION 24HRS.BEFORECONSTRUCTION <br />