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<br />everett p�ppLICATIC J► JR pUBLIC WORK� P�RMIT
<br />� TYPe or Prinl clearlY wilh ink _
<br />PRESS HARD - YOU ARE MAKING COPIES pERMIT NO. —
<br />PUBLIC WORKS
<br />EVERETT, WASHINGTON y�j BLDG. DEPT. NO.
<br />�OWNER LJAGENT DATE ��i—�� y
<br />APPLICANT/FIRM REPRESENTED _�4�� � � \ —
<br />ADDRESS ,�CJ�tS- ���,t`� nk• `•L CITY �D��L,� TELePHONE Li���<'�-'E"�
<br />HEREBY APPLIES FOR PERMISSION TO � � �`, `�� � �' - � � � ' { ' �' -'
<br />�^� ���� i
<br />AT THE� FOLLOWING LOCA710N �.�-�—i�'�� r� s'�'� — s� \ n' U.'� - l"�\��-'-�
<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.
<br />* Outline and dimensions of existing and
<br />proposed structures.
<br />* Existing and proposed utilities.
<br />* Centerline of abutting right ot way.
<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 � � r
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<br />PIJBLIC VUORKS PE
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<br />CONDITIONS: � �
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<br />';:;;:,�_ ���.,.,Fill may be Placed on the sitoA aa designnted.on the
<br />� _1..: -,�•plan, 9fiLY. �t70 FILL is to be nlaced in the ravine.
<br />------ --r- - - • �"nny oChar' fillin� Mill reauirle ndditional permits' ' '
<br />;; ": ; ,, and dotail Plans for handling of the existing culVcrt.
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<br />---' ""{r"'-' T jr 1^ �`�' -�:.. � j,:, ' The undersigned owner here6y agrees to holtl and save harmless
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<br />,�-�, � w. , .,,.,(�� ihe City ol Everelt trom any ano au claims lar damages, costs,
<br />� �'l;— '� ,"� �"7"t!: expenses, or causes ol aclion that may arise t.cause ol ins�allation
<br />�� � U __ ..,� °; { :_7;__ -'. ._:. .��.. and maintenance ol the improvement or other riFhFol-way use
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<br />�� i�}.�.....,,�� . hereto appliuA lor and lurther agr28s Io mmove 98me upOn notite
<br />, . � . . . . . � � •'� � _ ._.. � Irom the City and to re0lace public property damar�etl t�ereby.
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<br />APPROVEDFOR,CONSTRU TION DATE .. ACKNOWLEDGEMENTOFCONDIilONS
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<br />pPPROVEDASCONSTRUCTED - DATE SIGNATUREOFAPPLICANT y DATE
<br />PERIUl1T IS VALiD FOR 1 YEAR CALL FOR INaPECTION
<br />. POST ON 259-8811
<br />�;,.�� �� JOB�ITE 24HRS.BEFOFiECONSTRUCTION
<br />EXF�IRATION .
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