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. <br />everen APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYPe or Prinl cicBdy with ink �� <br />PRESS HARD - YOU AFE MAKING COPIES 7 <br />PUBLIC WORKS PERMIT NO. _ <br />EVERETf, WASHINGTON <br />❑ OWNER ��GENT DATE '�" ��-$ Z __ BLDG. DEPT. NO. <br />� � <br />APPLICANT/FIRM REPRESENTED ����('_iP��1Cl__C.. p _ . __._.- ._- ___ _. __ <br />ADDRESS ���L�L'� L�1�-,1-0•-�-- CITY `\ TELEPHONEoZJZ-77� <br />� . � , !_ , , . <br />HEREBY APPLIES FUR PERMISSION TO <br />AT THE FOLLOWING LOCATION �-3a <'-- <br />ra c�E ex�n <br />�vP/c1�p�„� (,va <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and sho�.v the tollowing as applicable: <br />` Property lines and street identity. <br />" Outline ard dimensions of existing and <br />proposed siructures. <br />' Existing and proposed utiiities. <br />` Centerline of abulting right of way. <br />CONDITIONS: <br />• Topographic changes requiring cuts and tills <br />other than normal foundation. <br />' On•site drainage systems when required. <br />" Erosion control methads when required. <br />' North arrow <br />' � <br />•> �` ..� -- <br />—''-L�-- - -'�'--- -- — <br />PUBLIC WORKS PER <br />�F.1(ac��vi` lS �-p �c,pP� 'S� c: 5 l�o � civ <br />, c� r � �.:. 1v� -Yv . � u � ( �C IC � �M/Q�'- C:Tz ' wa �/ <br />t..... / <br />�.....--._ . .... <br />i <br />I_. . . ... . . . . . . . . . _ . . . - _ . . . <br />F__-...... ,. <br />I... <br />i <br />�� �.f� "����-:� /1 �F � <br />� <br />Tne untlersigned owne� hereGy agrecs to hold and save harmless <br />Ihe Ctly o� Everell imm any 0na all claims lor damages, cosis, <br />Cepenses, or causes ol action Ihat may erise because ol inStallali0n <br />and maintenance ol �he improvemonl or other righ4obway u5e � <br />hCre�O applip.tl IOr and luriher agree5 �a fem�ve Seme upon n01iCe ' <br />Iwm the Gty antl lo replece public pmpetly demaged Ihereby. �. <br />DAT ACKNOWLEDGEMENT OF CONDITIONS <br />�� �,7� ,. , ' � � <br />� � �=- � ._ . <br />- - -- - <br />� �.;.. .��'l ----'�"�=�'�` <br />DATE SIG A'TURE OF AF ,�C,4NT DATE / <br />PERMIT IS VALID FOR t YEAR <br />EXPIRATION � ( �__ T � <br />POST ON <br />JOBSITE <br />CALL FOR INSPECTION <br />259•8811 <br />24 HRS. BEFORE CONSTRUCTION <br />� <br />