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e"e`e" qPp�,ICATION FOR PUBLI� MIORKS PERMIT <br />� TY7e or prinl clearlY wilh Ink <br />PRESS HARD • VOU ARE MAKING COPIES pERMIT NO. . /�� � <br />PUBUC WORKS � <br />EVERETf, WASHINGTON BLDG. DEPT. NO. <br />p9 OWNER ❑ AGENT D�.TE 7� 3 � � g� <br />APPLICANT/FIRM REPRESENTED o N r 1 �° o'"� a <br />ADDRESS �`��� 5���� S E CITY �`/�f�� TEL[PHONE�`�-�`11v1 <br />HEfiEBY APPLIES FOR PERMISSION TO <br />I\� � <br />ATTHE FOLLOWING LOCATION o�� O� 8,� �� � r L v$J P�� <br />Attach tive (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />* Property lines and street identity. <br />` Outline and dimensions of e.cisting and <br />proposed structures. <br />' Existing and proposed u:�litie�. <br />* Centerline of abutt.ng right of way. <br />LIC <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On-site drainage systems when required. <br />* Erosion control methods when required. <br />* North arrow <br />r-� (� (� <br />�' x `�k�� — <br />Signature ol Applicanl <br />RMIT <br />CONDITIONS: , __. _ . . _ . , <br />4..... . , i�. <br />. ; . . . . <br />� . . _ 1_ . _ : . . . : <br />. , <br />4 ,, � ' .. <br />+ , , .. n <br />� ..1 : , U _ . .... <br />� ,_ __._ .�. '�� . <br />i : : : , : , . . . �� ���� ��r : : <br />, � <br />—.. �...� :�. .i -�� .�: ... �:� ��v .._. <br />� - ._�.� . . ^�--- - , � �! -. . �;' ? � , ' , . <br />�� �� . � ��� � <br />� <br />i_ . � _i_ � -. _ . . . _ _ . l ��, ; --- <br />1 ' � �i <br />.;TI;�.. ,� . ��.... � .. <br />� I <br />� 1 <br />, � . . . i ; � i-__... . . . . . . 7 . . . . . . . . . . .. . . . . . . <br />f____ . _ �_}.__ r ... _ i � _ . . . ... f . . . , .��/ . <br />i �� <br />.� ..f.. �� <br />, .. �. ,. <br />�- — ;-�---`-r -���,"�"�T� i ,� ' The undersigned owner hereby agrees to hold and save harmless <br />�...�.,.....-I...;....�...i.... <br />� � � . _ .:-._ _ _. . . . . <br />. . .. ___._.._._.._y....._.. . . _ . . . . <br />. . . . �. : . .. l . . . . . . . . . . . . . . . . <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTFUCTED D.4TE <br />PERMlT IS VALID FOR 1 YEAR <br />EXPI RATION <br />the City ol Everett Irom any antl all claims b� demages, cosls, <br />expenses, or causes ot aclion that may arise 6ecause ot installation <br />and mainlenance ol Ihe improvement or othe� righl-ol�way use <br />herelo apPliad tor and luriher agrees .0 remove same upon nolice <br />irom Ihe Cily and tu replaco publ�c property damaged thereby. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />SIGNATUREOFAPPLICANT DATE <br />CALL FOR 1 NSF'tt. i evrv <br />POSi ON 259•8$11 <br />JpB51TE 24HRS.BEFORECONSTRUCTIOP! <br />