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everen APPLICA. �ON FOR PUBLIC WO�.�(S PERMIT <br />� TYPe or Print tlearly wil� ink � <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. ����%��l <br />PUBLIC WORKS � <br />EVERETT, WASHINGTON �� „ , � BLDG. DEPT. NO. LU� ��� <br />�OWNER ❑ AGENI' DATE _ %���_ IJ ����/� <br />APPLICANT/FIRMREPRESENTED �/=/��__ �J�S�/��So.�%_. _ _ _ __ _ <br />ADDRESS �O. �� l�p- � i�J �,Jr i J e _C,�Ty � Jc,rc�� TELEPHONE �S S� ���y <br />HEREBY APPLIES FOR PERMISSION TO 1 uSf� II (�/r,-v �l/A.� <br />AT"iHE FOLLOWING LOCATION ��� �� � /^JA ��v� <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. " 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 contr I m i�ds when required. <br />' Centerline of abutting r ght of way. ' Nort L�rrqy�� � <br />�,.�� <br />ignature o� Applicanl <br />F`UBLIC WORKS PERMIT <br />CONDITIONS: <br />APPRqVED fOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATI�N <br />�c c � �ss v �� �a,��y <br />T^: c /J /e= . �sc F <br />c'77?�J/ <br />I <br />The undersignetl owner �ereby agrees lo hold end save harmle5s <br />Ihe Ciry of Eve'ett trom any ana an clalms lor demepes, coste. <br />eMoonses, or causes ol action I�at may ariso becnuse ol instellation <br />antl meintenance ol Ihe improvemenl or ot�er ripht�04wny uso <br />hereto appliod lor end lurther a9��es to remove same upon notice <br />Irom the Ciry and lo r801aco pu6lic pmperty demaged t�ereby. <br />ACKNOWLEDGEMENI' OF CONDITIONS <br />SIGNATUREOFAPPIICANT DATE <br />POST ON <br />JOBSITE <br />CALL FOR INSPECTION <br />259•8811 <br />24 HRS. BEFORECONSTRUi.T10N <br />