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r <br />r <br />r <br />114 <br />G APPLICATION FOR PULLIC WORKS PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. <br />PUBLIC WORKS <br />EVERETT, WASHINGTON - <br />BLDG. DEPT. N0. <br />❑ OWNER X I AGENT DATE _ ,'/'/b -6/ _ �; <br />APPLICANT/FIRM REPRESENTED l�Fc✓t-4.0 COAST <br />ADDRESS � Ur do,( 9S3 CITY f✓E/IEii TELEPHONE Z110-%l5/ <br />HEREBY APPLIES FOR PERMISSION TO _ IiJ.S7W4L /6�hE242y 6' <br />T-3%DF4'JAG.Cs AS 5WbtwV oN Sr7i liq_An/ <br />AT THE FOLLOWING LOCATION __ 8J/7 ..SE•✓W771 dire- 1-VE?Lrr <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'han 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 r'ght of way. * North arrow <br />5'gnalure of Applicant <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />` ... �-o b: << •- i r>" c r�� . �� . Sl.e�-�-s f}�, c�n� M ) <br />. .� i.:.f��� ,'-�x�:.-. �: �. _Pbtlolic ('�lJ or� •� 3/ 7 N/ $ 2-_. .. _ <br />�. <br />........... <br />The undersigned owner hereby agrees to hold and save harmless <br />. , the City of Everett from any and all claims for damages, costs, =1 <br />expenses, or causes of action that may arise because of installation �v <br />-- --- - — - - - and maintenance of the improvement or other right-ol-way use <br />. . ' . ' ` - j hereto appl!-d for and further agrees to remove same upon notice (� <br />from the City and to replace public property damaged thereby. ,r <br />4PPROVE D -F7 C TRUCTION /= DATE ACKNOWLEDGEMENT OF CONDIYIONS <br />4PPROVED AS CONSTRUCTED DATE SIGNATURE OF APPLICANT DATE <br />PERMIT IS VALID FOR 1 YEAR POCALL FOR INSPECTION <br />if - POST POST <br />ON 259.8811 <br />EXPIRATION . 24 HRS. BEFORE CONSTRUCTION <br />-1 <br />I <br />L_ J <br />