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�everett APPLICATION FOR PUBLIC WORKS PERMIT <br />Tvpc or PriN cleetlY with ink <br />PRESS HA�'D • YOU ARE MAKING COPIES pERM1T NO. �"' '�� �� <br />PUBLIC WORKS --'-" - — <br />EVERETT, WASHINGTON BLDG. DEPT. NO._ __ ���-' <br />! . i -- <br />❑ ON'NER ❑ AGENT DATE . . '__. ' . _ _ _ <br />APPLICANT/FIRM REPRESENTED .'_ _^l �. /t__. � r' . � i � '� / r � � ,./�� r:�'� � <br />ADDRESS ___________��-<�_ CITY __ � �� r __ _TELEPHONE <br />HEREBY APPUES FOR PERMISSION TO �q � ` � ' ' � ��� __ � : : ___ �_�_�___ 1� _ __ __ __ <br />ATTF�G FOLLOWING LOCATION _�l_fPLq_. _�'____L•'�.5 -_____-S:�_ _ _ _ __ _ <br />Atlach tive (5) copies of preliminary plans for prop�sed work. Draw to scale and show the following as applicable: <br />' Property lines and slreet 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 conirol methods when required. <br />` Centerline ot abutting right of vvay. ' North arrow <br />— ; i '� <br />- �--� �- �- ---- SipnaW�e�olApPli[xnl-- <br />PU�LIC WORKS PERMIT <br />CONDITIONS: <br />\,. _ , <br />c,� <br />. ,. , <br />� <br />�. ,, f : l. "_ ; <br />___ nier <br />-- 3��( �_Z-- <br />DATE <br />llic unAmsigncd owner �meby anrocs ;o holtl antl snve harmle55 <br />Ihe Cily uf Evereti Irom any an0 all cia�ms lor tlamages, cosis, <br />expunse5, ot causes ol aCtion I�ll may arise 6e[ause 01 inSlallaiion <br />antl inainlenance N Ihr improvement or o��er ri9�4obway uso <br />ficreto apuLr,tl fer and Iurihar agree5 to remove 58n8 upon notiCe <br />Irom Itic Gily and lo nrpiaCe publlr, propetly ]amegCd tAereby. <br />ACKNOWLEDGEMENTOFCOND S <br />..,. �--._ ir_�-;.�. <br />EIGNATUREOFAPPLICANT � DATE - <br />CALL FOR INSPECTION <br />259-8811 <br />24 HRS. BEFORECONSTRUCTION <br />PERMIT IS VALIG FQfi 1 YEAR <br />POST ON <br />�� JOBSITE <br />EXPIRATION � <br />