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<br /> everett pppLICATION FO�i PUBLIC WORKS PERMIT
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<br /> PRESS HARD•YOU ARE MAKING COPIES pE..M1T NO. �"� �
<br /> PUBLIC WORKS .,�
<br /> EVERETT.WASHINGTON BLDG. DFPT. NO. �1L•�
<br /> f�-OWNER ❑ AGENT DATE _LL'__L�—��--
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<br /> APPLICANT/FIRM REPRESENTED _—__- / 5��4
<br /> p N�✓��G�_?ELEPHUNE �—
<br /> ADDRESS �v d� W �� CITY
<br /> 2��o�, �,��B �v,✓c P-�r�_!�� vrWk �N9�Au�
<br /> HEREBY APPLIES FOR PERMISSION TO
<br /> %s' 2 3 qv,� r,v, �or s bi� 2 G�'.��-o,��,4�s/i�-�/
<br /> ATTHE FOLLOWING LOCATION ��� ��E' ��' ---
<br /> Attach five(5)copies of preliminary plans for proposed work. Draw to scale and show the fcf�owing as applicable:
<br /> * Property lines and street identity. * Topographic changes requiring cuts and fi:ls
<br /> * Outline and dimensio �s of existing and other than normal foundaiion.
<br /> proposed structures. * On-site drainage systems when reauired.
<br /> ` Existina and proposed utilities. * Erosiun contrc>I mathods when required.
<br /> * (;enterline of abutting right o' way. ` NoR ar ow
<br /> �, �natu�;APPlica� �
<br /> coNoirioNs: PUB�LIC WORKS PE�iMIT
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<br /> -s •--� i f �i i � '� �� � � � ,-� f � 7he untlersi9ne4 owner hereby agrees to hold and save �a�mless
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<br /> • - �---� � � ��`�-��'- ' . �. ������� � tFe Ciry ol Everett tmm ai.y antl a1i ciaims lor demegee, cos9.
<br /> � � � � ' � � expert�c,or wuse5 0l aclion ihal may ari5e beCause of Inatellation
<br /> and -•�.,�a��enance of Ihe imp�ovament or other riqhPof-way use
<br /> her:�to nV��ied lor and lurther agrees to remove aeme upon no�lce
<br /> j Iro�:� �he Jity anc' to replace public proDerty dameged t�_reDy.
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<br /> p,r.pROVEG F0 CONSTRUC D E c3 AGI$N�LE ��NT OF CONDITIONS /O-GU'��i
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<br /> SIGNATURE OF ICAN DATE
<br /> PROVED AS CONSTRUCTED DATE :� -�—
<br /> PERMIT IS VALID FOR 1 YEAR CQ.LL FOR INSPECTION
<br /> POST ON 259-8811
<br /> JOBSITE 24 HRS. BEFORE CONSTRUCTION
<br /> � EXPIRATION -
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