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w. APPLICATION FOR PUBLIC WORKS PERMIT <br />� Type or print Clearly wil� ink <br />PRESS HARD • YOU ARE MAKING COPIES pERM1T NO. �', ��� <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. NO. <br />�!?WNER ❑ AGENT DATE �3 Z <br />APPLICANT/FIRM REPRESE <br />ADDRE9S 1,1_LL���O�^� y'� CITY �� e F c t Y TELEPHONE �(,S1 Z7 �/ � <br />HEREBY APPLIES FOR PERMISSION TO-�_„��1L�—�-b jL � y��S �•���n�C. <br />vt Ti�.iztti.I� >>�wr� d-ci��y; L=xrnznk�� <br />ATTHE FOLLOWING LOCATION �% �Q—��� �'�'� x�+►Y=�'{ �.�/i���P J <br />Attach five (5) copies of prelimi�ary plans for proposed work Draw to scale and show the following as applicable: <br />• Property Iines and street identity. ' Topographic changes requiring cuts and i(Ils <br />" Outline and dimensions of existing and other than normal foundation. <br />proposed structures. ' On-site drainage systems when required. <br />` Existing and proposed utiliHes. • Erosion oontrol methods when required. <br />' Centerline of abutting right of way. • North arrow <br />�., .. ,...{ ......� ...... ... . �.... <br />. � � . , j 1 . . 1 � _. . . �y . # . . � . ~ . . . I .. . , • . ! . . '.__.. : . <br />� <br />:_ , :: <br />. ' ; ; _, ,_i ___-----rt--------�---.-i--�-. � . ---�---�-__ � : - . _ <br />...; . .... . ; i .' ... <br />_.�:.� ^ :. :f... :.:i:.:.`..:�:: . .:: ..;.�.1 :_. <br />. �� ,. i: ,. <br />i . . ._ .�_�_.�. _ � � �t _.� ;� __ • ___1_ . <br />. � : i ..i...� .:;..:, ..' f i � i,.. <br />.—.-�— �-- ; : , . . . ,� ._._ _ . . _ . , _ . _ . . _ . . . . : <br />...... � .. l <br />�;_.�._ . <br />��1 _� I • <br />, ,y � , , , i , , , , , , , a , , . 1 . . lhe untlersignetl awner �ereby egrees to holtl end save �armless <br />. , , . , , � . . . . . . . , . . . . Ihe Cily ol EvereU trom nny ana an claims far demepe0. cosls, <br />. ..... . . eaponses, or ceuses of ectlon Ihet mey erlae beceuse ol Inatelletion <br />. . . . . . . . . . . . . . . . . . and maintenance ol ihe improvement or other tlph4obwey uae <br />�- ��- �- � �ereto ap011ed lor end luriher e0reea to remove Sema upon noliCe <br />_/% J� � irom t�e Ci�y and to replece puElic p�oparty tlemeqe0 Ihereby. <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION ���r t' S <br />�� C � <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� SIGNAT�PP�T ATE <br />CALL FOR INSPECTION <br />POST ON 259•8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />