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<br /> `"°`"` APPLICATION FOR PUBLIC WORKS PERMIT
<br /> � Troe or ptln!cleadr witn ink � �
<br /> PRESS HAfiD-YOU AAE MAKING COPIES R
<br /> PUBLIC WORKS PERMIT NO. " ��
<br /> EVERETT,WASHINGTON BLDG. DEPT. NO. � O .S� I
<br /> �OWNER ❑ AGENT DA7E '� !��
<br /> APPLICANT/FIRM REPRESENTED ����'�� �J�
<br /> ADDRESS �i .S� �: ��i t��A'�- GUA'� CITY���� TELEPHONE 3.�y�F-yL
<br /> II HEREBY APPUES FOR PERMISSION TO ����' d'S� W�v� C�/!/«� a�7P�V��/��
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<br /> ATTHEFOLLOWINGLOCATION w� �. ✓"+�^`t �5"`� S "7� 09 � — �e. W
<br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the following as applicable: I
<br /> * Property tines and street identity. * Topographic changes requiring cuts and fills ,
<br /> * Outline and dimensions��f 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. * arr w
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<br /> neture of Applicant
<br /> PUBLI�C W+DR PER T
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<br /> i . � . ' •-_ �" . ; ,._- • � • • ; � • • , � _ • . '. . , . Ti�e undersiBned owner herehy agrees lo hold and save harmless
<br /> !, _ , , , , , � , , , � . ; , � . : . : . . : : . . . .. . . . the City ol Everelt trom eny ana all claima for damaqea, coats,
<br /> � . . . : . . . . . . . . . . . . . . . . . . . . . . . . . ezpenses,or ;auses of action that may adse bxcaune ol installation
<br /> j__. . ...... .. .__ L.. _. . . . . . : . . . �._'.___._..__.__. .. __ . and maintenance ol t�e ImProvement or other riBhUoFway uee
<br /> '� � � � • � � � 1 � , � � � � � � � � � � � hereto epplled lor and further egrees to remove scme upon notice
<br /> ��,� �. . � : � Irom the City and to replaca public pmperty damaqed thereby.
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<br /> �APP O E OR CONSTRUCTION OWLEDGE EN OF CON�ITIONS —
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<br /> APPFOVED AS C N TR CTED DATE �'" ATUR PLICANT DATE
<br /> PERMIT IS VAAL FOR YEAR pOST ON CALL FOR INSPECTION
<br /> 259-8811
<br /> � EXPIRATION JOBSITE 24 HRS. BEFORECONSTRUCTION J
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