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.- <br />APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES 7 <br />PERMIT NO. <br />PUBLIC WORKS - <br />EVERETT, WA,SHINGTON BLDG. DEPT. <br />❑ OWNER y AGENT DATE n <br />APPLICANT/F RM REPRESENTED <br />// _11I1�1]]lli�-l� y f �S U_I it,), J�IJ�' 1� !\ l� l (� 111A./.1 <br />ADDRESS 3 to d 5- �l r ri�f r R CITY LK ii? f - TELEPHONES 5 ,� - / /ZLta_ <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION �._LL-'t •L� ;5: _ r_�f_�.�- L.CJF� C1 (r L�. <br />Attach five (5) copies of preliminary plans for proposed work. Di aw to scale and show the following as applicable! <br />• Property lines and street identity. <br />• Outline and dimension: of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />CONDITIONS: <br />PUBLIC - <br />Topographic changes requiring cuts and fills <br />other than normal foundation. <br />Or. -site c: ainage systems when required. <br />" Erosion) control methods when required. <br />*.North arlow <br />c ; --. — <br />�1 �ignalure of Anpb—`Gant <br />j �UJ 'CIO <br />Srna11 axis�;n drve .\y_citpr.�e,<. j <br />q hear Cor nsr o <br />. �1� Q QnL{K� ,\NN9 bC f[v..oV �� wrnY CG�Ia er J! <br />.1Wr�i'+ -FN 1t C`vtr10. tr .•� ;'�h ct, R'� S\c�@w�•1k_ 1 C <br />arr\. DIE ItN L�.(�(' rVIN Ni 6C '(elci.co,41,' <br />1 , <br />` f \ d <br />. Ah CP CI kiCP Sl.\\. wtcl �'�+ �Yt(IAX In.nM I.vlei ��\'1 2J JPn <br />L 11 ( 1 1 <br />r do ro-AcA `l, _ CeAer A- Cr K\n` I-o � nrl J.lo niS�G <br />a5 oI,I . Pan V <br />PERMIT IS VALID <br />EXPIRATION <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any ano all 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-of-way use <br />hereto applied for and further agrees to remove same upon nctice <br />from the City and to replace public property damaged thereby. <br />DATI ACKNOWLEDGEMENT OF CONDITIONS <br />DATE sidvi JRE OF APPLICANT DATE <br />1 YEAR CALL FOR INSPECTION <br />POST ON 1 259.8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION p <br />11 <br />