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--�i <br /> - -- ------- ----�i _.-- <br /> '� �everett qppLICATION FOR PUBLIC WORK� PERMIT ' <br /> TYPe or print cleady wilh ink , <br /> I PRESS HARD-YOU ARE MAKING COPIES pERMiT NO. ' �'� �-� I <br /> PUBL�C WORKS i <br /> ' EVERETT, WASHINGTON ` ' <br /> i ', / = ` j d;`..( BLDG. DEPT. NO._"'.;�/iG'«�ri -- <br /> i ❑ OWNER �AGENT DATE � � <br /> � APPLICANT/FIRM REPRESENTED � ' 'S��'rn�� • ` � � , � - � / l , / 'fry �f r j� <br /> � - —---- -------- -� -- -- - -----='. ��c..�. `" <br />� I iii,� �;,j;' , � -- f . _ _ � , <br /> ADDRESS __ CITY ____ '' " � � TELEPHONE ` �' �" ' ' ' � <br /> —- /� / <br /> � HEREBY APPLIES FOR PERMISSION TO ���' �' ' �' � �' � = ` �• ��( �' <br />�� �� <br /> ATTHE 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 filis <br /> * Outline and dimensions of existing and other than normal foundation. <br /> proposed structures. * On-site drainage systems when required. <br /> * Existing and proposed utiiities. * Erosion controi methods when required. <br /> * Centerline of abutting right of way. * North arrow <br /> � „ �_' , / i . <br /> — — / ' ��._ ' '��• <br /> 1 <br /> Signature ol Applicanl <br /> F`UBLIC WORKS PERMIT <br /> CONDITIONS: <br /> i'ror.t��� ou :�tii S�reet �Lali Le �ull; iP�:roved witt� curb, �ucter an�i <br /> sidec.alk, xnd addltiunal paving ae deterr.:ined by the Public Works liepartr�enC <br /> (per sectiou 16 of the Shoreline Mnnngement Perudt) or at the City of <br /> �verett's discretion this reG;�irement cwy be met by Local Improvement <br /> Uistricl- or otlier direct finuncing for eimilar public inprovcs+iente. <br /> � � ihe undersi ned owner hereb a rees to hold and save �I I'� <br /> 9 y g harm ess <br /> Ihe Cily ol EverNt Imm any ana all claims br tlamages, costs, <br /> expen,es,or causes of action thal may arise 6ecause ol installalion <br /> and maintenance of the improvemenl or other riph4ohway use <br /> hereto applied for and lurther agrees to removo same upon no�ice <br /> � Irom the Cily antl to replace public property damaged Ihereby. � <br /> / / r�� <br /> ' ^.r /lwi�( /���i�./-- 7� %,�' �_.. � <br /> fIPP �� �D F CONS�RUCTION �i DAjE ACKNOWLEDGEMENT OF CONDITIONS <br /> . . , � �. � � ,�)��� .., - '� - - �� ,.",'.' . .___. <br /> 41 Y> <br /> .". . . - � ." r <br /> APPFiOVED AS CONSTRUCT � DATE $IGNATURE OF APPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 <br /> EXPIRATION JOBSITE 24HRS. BEFORECONSTRUCTIQN <br />