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<br /> � APPLICATION FOR PUBLIC WORKS PERMIT
<br /> Type or print c:�rly wllh ink
<br /> PRESS HARD-YOU ARE MAKING COPIES
<br /> PUBLIC WORKS PERMIT NO. 83��_
<br /> EVERETT,WASHINGTON
<br /> ,�Q OWNER ❑ AGENT DATE ����lf_m_/p�� BLDG. DEPT. NO. _
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<br /> APPLICANT/FIRM REPRESENTED i�f.�T,l_X�C���•��J,�T , ____ �
<br /> ADDRESS �_3.� Si✓��//i, +%'„Sy />'i - CITY,�d�=:i' -ii TELEPHONE.--�-�t� -o,dop
<br /> HEREBY APPLIES FOR PERMISSION TO �.r%=,r/��� � /� �ij'6 9- ` y �i �� � , - � _ _
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<br /> ATTHE FOLLOWING LOCATION �i��� : �� �' . + , .' �;J�;,= �_;�,_,,f ��-
<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 ii:entity. • Topographic changes requiring cuts and fills
<br /> • Outline and dimensions of existing and other than normal foundation.
<br /> proposed structures. • On-site drainage systems when required.
<br /> • Existing and proposed utilities. • Erosion control methods when required.
<br /> ' Centerline of abutting right of way. • North arrow
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<br /> Sgnature of Apphcent
<br /> coNnirioNs: PUBLIC WORKS PERMIT
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<br /> f �� I-�� }t -{'-'--1 � -� i The undorsigned owner hereby aqreas lo hold and seve�armlesa
<br /> j— �—_y_�� i-f_� � T 4 the Cily ol Everett Irom any antl all culma br dim�pa�, cp�t4
<br /> � ��� f.._,i � -�j 1 T �,"__ expenses,or causas ol eclion�h�t may eriee Daques of in�1�14tbn
<br /> � ._ I. .._I I_ f . f �. i � 1 � . .. entl maintenanca ol I�e i m P r o v e m e n t o r o t�e r tl p�t ro l-w�Y u�e
<br /> - , �� hereto applled lar antl�urihar eqroee lo remove e�me upon notke
<br /> Irom I�e City and to replace puUlic property damaped t�ereby.
<br /> APPROVED FOR CONSTRUCTION DATE ACKNOWLEDGEMENT OF CONDITIONS J
<br /> APPROVED q5 CONSTRUCTED DATE SIGNATURE OF APPLICANT DATE
<br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION
<br /> POST aN 259•8811
<br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTION
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