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�everett qppLICA�'ION FOR F'UBL�C M/C)RKS PE�3MIT <br />TYPe or Print cleadY with ink <br />PRESS HARD - YOU ANE MAKING COPIES �S3 J 3 <br />PUBLIC WORKS PERMIT NO. _ <br />EVERETT,WASHINGTON <br />,[ZOWNER ❑ AGENT DATE %� �'� •`f � _ B! DG. DEPT. NO. <br />APPLICANT/FIRM REPRESENTED <br />e <br />ADDRESS ���' �S< <LclZc�'T /�j/�J-t C L{/A ,�_CITY C�E /Zc' %7� TELEPHONE �i5 � �/44� <br />HEREBY APPLIES FOR PERMISSION TO �NS1R�t �S � !-Ui�E �'�Nrk�E,�z- �j�,� ����:-;��,q y <br />ATTHE FOLLOWING LOCATION lC%T v'-3 UC.Of�C�.+Uc> E S>/lFS- %aj'j (o %���, W, <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the follawing as applicable: <br />" Property lines and street identity. <br />` Outline and dimensions of existing and <br />proposPd structures. <br />" Existing and proposed utilities. <br />* Centerline of abutting right of w,.,, <br />" Topographic changes requiring cuts and filis <br />other than normal foundation. <br />* On-site drainage systems when required. <br />' Ecosio control met ods when required. <br />l�North ar oyr- <br />- ,_ / �`,� � ��`] �' <br />BLIC WORKS� PER <br />CONDII'!ONS: <br />. . ., / //� <br />. . . . . . . � �/Pln.'�P/� PQS�F :nP.<.T G.rlci /7 .vc� � E7r C/PttrP�..`��� <br />i . . . / <br />' . . `l. /�UO �-�P a/lJi�r,vft M✓S � �ir cv.ti7�iv�� �� ar� 1flP �c y-, <br />� <br />�.... / � n/ <br />;... 3,: ;W,�usi iv�v�e/ 5�-��.� e G��-�� ,G: K -� ��,.:� o�" �•i� e. <br />.., .. ... . , <br />( ; . � � � : .-1 , -_____ { _�. � _: � _ <br />f...':. I:::,:::�...�::.i :::.::::.::.: <br />. . . . . . , ; . . . ! ��_ . . ; . . : . . . <br />f.�_: :: ._ t _. . ? : . . � --�_: - _-_ �---._ ._i_.. <br />.. . ...�...;...... <br />�.:.:.:'i...;...�...�.. <br />.__ �;T.�.�-- --- —. . . . . <br />; : : � �: - � ( � �^ � ; � � : � . - - . The undersignotl ownei herecy agrees to hold and savu harmless <br />. . • i� ., . i� the Ciry ol Everett tmm a�y ana au claims for damages, cos�s, <br />' � � � ' ' ' ' ' � � ' � � � ' � � � - - � expenses, or wuses of action ihat rray arise �ecausa ot Installation <br />� � _ . � � ' : � � � � - - - ' - � � � � � antl maintenance ol Ihe improvemenl or other �igh4of-way uae <br />� ^ � '� � her�,to applied tor antl lurlher aqiees to remove same uoon notice <br />PERnn�r is <br />EXF�IRATION <br />� 3-f3 <br />DAIE <br />� T'�,3 <br />imm �he City antl b replace pu6lic propetly damaged �hereby. <br />OF CONDITIONS <br />f �� ,_� <br />D FOR � YEAR � CALL FOR INSPECTION � <br />POST ON 255�•8811 <br />JOBS�ITE 24HFtS.BEFQRECOWSTRUCTION <br />� <br />