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APPLICATION FOR PUBLIC WORKS PERMIT <br />© Type or print clearly with ink <br />- <br />PRESS HARD YOU ARE MAKING COPIES PERMIT NO. ell-7' <br />PUBLIC WORKS BLDG. DEPT. NO.— <br />EVERETT,WASHINGTON�6? 9/ <br />❑ OWNER ❑AGENT DATE �� JLI4 3 � <br />--- <br />�'�Jti <br />APPLICANT/FIRM REPRESENTED / 5 S 3 . -71 4 z <br />CITY - -_L TELEPHONE) <br />ADDRESS — <br />HEREBY APPLIES FOR PERMISSION TO <br />Y. si A-Y� �' —U-, Lo yJ <br />AT THE FOLLOWING LOCATION <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. <br />• Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On -site drainage systems when required. <br />• Erosion control methods when required. <br />♦ al..rlh aarnW I __._ <br />CONDITIONS: <br />en re n/i17 n�a;rLtai� <br />r Y <br />N <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, cost& <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of the improvement or other right-ohwaY use <br />hereto applied for and further agrees to remove some upon notice <br />from the City and to replace public propertydamaged <br />CONDITIONS <br />---$— AS C -I TRUC D um' <br />CALL FOR INSPECTION <br />PERMIT IS VALID FOR 1 YEAR POST ON 259-8811 <br />l�rc�I L JOBSITE 24HRS.BEFORECONSTRUCTION <br />EXPIRATION— - ---- <br />