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I <br />everett APPLICATION FOR PUBLIC WORKS PERMIT <br />Re Print clearly with in <br />PRESS HARD <br />- k <br />RD -YOU ARE MAKING COPIES <br />PERMIT NO. — a <br />PUBLIC WORKS <br />EVERETT, WASHINGTON _ A / BLDG. DEPT. NO._ <br />❑ OWNER gAGENT DATEe �7p-//j[Wf) <br />APPLICANT/FIRM REPREE�SENTEE�Dh__/C �/c%S___/'/G'�/Y_ <br />ADDRESS C �'__(_—_rc-CITY �'O_ /TELEPHONE_���'��� <br />HEREBY APPLIES FOR PERMISSION TO,(_U- 71, 7-/iL- LIf!_ _—'Z' �2 <br />7 � <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. * 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 <br />X_ - <br />- Signature pplicant <br />CONDITIONS: PUBLIC WORKS PERMIT <br />eyvnnovL WOn <br />rtiw c5/ vt 5t o. l I 1 y �e Z CNw,P.1 i- �O y cre.-�e IXYnt,ue—� <br />Oc=� :s+& . V I a # 3 w/ Cu Flo - j rU j' / of ro ^ c. , Y <br />I <br />new lv "tdi_ s r c�r,k/c��Ic. 4-e •� 0,.•.... , <br />PERMIT IS VALID FOR 1 <br />EXPIRATION <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett tram any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />:2_+­z, <br />ENT OF <br />to L <br />CAWFOR INSPECTIO14 <br />POST ON 259.8811 <br />JOBSITE 1 24 HRS. BEFORE CONSTRUCTION <br />