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� <br /> - -, <br /> �"�""` APPLICATION FOR PUBLIC WORKS PERMIT <br /> TYPe or Print clearly wit�ink <br /> PRESS HARD-YOU ARE MAKING COPIES <br /> PUBLIC WORKS PERMIT NO. � y I I � <br /> EVERETf,WASHINGTON <br /> ❑ OWNER ❑ AGEN� DATE � �� � �Z BLDG. DEPT. NO. - i, <br /> � -- <br /> APPLICANT/FIRM REPRESENTED Ciu6//'✓1/,� :�yq����� <br /> ADDRESS ��°� .� c�;��G��:J � ��Ty �v.ici>Ir TFLEPHONE _ Z5 Z 3G i; <br /> HEREBY APPUES FOR PERMISSION TO n'��''��7 7 !� �o I uO 4 7��f y- � ! <br /> �:ai -, c� �� . ; �,��f� ),9�c,n�.,/ �rv,c� /Z ,� ��_ � r <br /> ATTHE FOLLOWING LOCATION �7 2J�� ���qL�urt rt <br /> Attach tive(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> ' Property lines and street identity. ' Topogi�phic changes requiring cuts and fills <br /> • Outline and dimensions of existing and other than normai toundat�on. <br /> proposed structures. " On-site drainage systems when required. <br /> ` Exi;ting and propos6d utilities. ' Erosion control methods when required. <br /> ' Centerline oi abutting right of way. * North arrov,� <br /> _�� ✓�/�:x.�z,. ,.� <br /> - Signet re ot AppliceN -- <br /> PUBLIC WORKS PE!RMIT <br /> CONDITIONS: <br /> . , , ; . . i . . . . . � / <br /> , . �'/ % <br /> .' <br /> . ' � . � I . . . . � . . / ' <br /> �_� __ . . . . . - - . " , / /' �. ' / L � <br /> . . , � i � <br /> ._.�_ .__ _ . � � ' ` <br /> _ �� � � �� I I <br /> � : � : ; : � ; � <br /> ; - .�i ��.. � . - _ . � �-� i <br /> � �: ; : � i � / - � <br /> . � � ' �� , <br /> ._ . : . . : . ; . . . . . � / <br /> � <br /> /� Tne undersyneA ownen c�reby agrees lo holtl and save harmless <br /> Ihe CIty ot Everett irom xGy an(1 a�1 c�aims br tlamapes, coetL, <br /> i � ¢%p¢n923.OI CBuS¢5 OI dCti00�htl m8y BfI6B bBC9U9B OI ibBI91101100 <br /> � ' and mninlenence ol Ihe improvement or olher rig�ho4wey uee <br /> � hereto apP��ed lor antl Iurihef egree5 lo femOve SFme upon nOliCe <br /> irom the City anA to replace public prcnetly damagetl Ihereby. <br /> 1 <br /> APPROVED FOR GON$TRUCTION DATE ACKNUWLEDGEMENT OF CONDITIONS <br /> APPROVED AS CONSTRUCTED DATE SIGNATURE OFAPPLICANT DATE <br /> PERMIT IS YALID FOR 'I YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> FXPIR/lTION JOBSITE �qHRS. BEF()RECONSTRUCTION <br /> ' t. <br /> '1 <br /> . <br />