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_1 <br /> �everett qppLICATIGN FOR PU�LIC WORKS PERMIT <br /> TYPe or print clearly with ink <br /> PRESS HARD•YOU ARE MAKING COPIES <br /> PUBLIC WORKS PERMIT NO. 3_l�_ <br /> EVERETT,WASH GTON BLDG. DEPT. NO. �� ��`�J <br /> ❑ OWNER �GENT DATE I - �I - �J 3 ( <br /> APPLICANT/FIRM REPRESENTED _,)�_(�S6E tJ ��_y_N�GD� �� �� <br /> ADDRESS '� \U5 � �� �7" CITY _EV���� TELEPHONE Z�P� - <br /> �� <br /> HEREBY APPLIES FOR PERMISSION TO �-^�1��i'� tl� T I�CflU�/ �N�+ 1 PM��-t' ��p/{��� ar{�,� <br /> AT THE FOLLOWING LOCATION 1 i 1:G, l3�- �'� <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 chenges requiring cuts and fil�s <br /> * Outline and dimensions of existing and other than normai foundation. <br /> proposed structures. * Cn-site drainage systems when required. <br /> * Fxisting and proposed utilities. • Erosion control methods when required. <br />, * Centerline of abutting right of way. * North arrow �- <br /> � :���i� <br /> nature ol Applicagl�"� <br /> PUBLIC WGRKS PERMIT ` <br /> CONDITIONS: <br /> : : . . . : �'�''I ���L,�s �'�.%`�r�o� ��;3 <br /> f : . " : : : : . <br /> . , . <br /> . . . . . . . , . . . . , <br /> ___:__`_�,__ <br /> r---------_..� .---_._. . _ . _ , <br /> . . _ _ _. .__ <br /> , . , . . . , . . . . . ; . . . , . . . <br /> : . : ; : : : � : : : : : ' a . , . . : : : : : � : . : <br /> ; , <br /> . <br /> :._ �.�._ . . ' . . _ . . . . . <br /> 1__ . .. _ .. . - _t . ._. . <br /> ; � . � . . . i , . . . . : . <br /> ; i , : ; . . : � : : : : . , <br /> : .- :.�:--, . ---, . --: _ _ _�-_ <br /> . . . . , , . . . . . : . . . } . . ; <br /> �:__ : }_; � :� :_ _�. � �_: <br /> , <br />� . . � . :: , . <br /> . . , . . , . , <br /> ; � �;_ : _,-�_---__.T . . <br /> � , � t • The untlersigned owner hereby agrees to holtl and save harmless <br /> � � - �� I �� � • ! � � � t � � � , • � the City of Everelt Irom any antl all claims lor damages, cosls, <br /> ' � � ' ' � � ' � � • � expenses.or causes ot action�hat may arise because ol installa�ion <br /> � � � � � " ' � � - � � � � and maintenance of the improvement or other righPoi�way usa <br /> � � � hereto applied lor and lurther agrees to remove same upon notice <br /> � � � � (rom the City and to repince public property dameged ihoreby. <br /> 3 . � � <br /> i <br /> PPR VED OR CO S TION - D E ACKNOWLEDG'c , NT O�ONDITIONS `� <br /> � � �� i <br /> / S•�� -� 3 • �'�, 3-2 -��5 <br /> PP VED AS CON TRUCTED DATE SIGNA U T A T�qTE <br /> PERMIT IS VALID FOR 1 YEAR CALL � R IN PECT;ON <br /> POST ON 25 _ 11 <br /> EXPIRATION � JOB�ITE 24HRS. BEFORECOfVSTRUCYICN <br />