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r <br />`^I <br />r <br />APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with Ink �j 1 <br />PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. — <br />PUBLIC WORKS Q <br />__ <br />EVERETT, WASFhNGTON (I•�41 z BLDG. DEPT. NO.fI-_�.LL��s <br />CI -OWNER ❑ AGENT DATE J <br />APPLICANT/FIRM REPRESENILD _.AUr DIt-E <br />ADDRESS _?� !' 2��^_� -rR 6-W' —CITY TL�-L\fIUNC <br />HEREBY APPLIES FOR P2RMISSION TO Ta2UIl.7----- <br />--------{___-3X --- -- <br />AT THF. r0LLOWING LOCATION-Z�_IS� �? (%-p ��� �� — <br />Attac.t five (5) comes of prelimlrary plans for proposed work. Draw to scale and show the following as applicable: <br />• Propf rty lines and street identity. <br />• Oulline and dimensions of existing and <br />p oposed structures. <br />• Ex'ating and proposed utilities. <br />• Centerline of abutting right of way. <br />M <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On -site drainage sterns when required. <br />• Ergsioq con meth s when required. <br />• r.1" d <br />19;l <br />CONDITIONS: <br />/4C/✓SS /ro .o ><e e e /n c'i �y !/��/rJ� /� <br />�. COA �/'/«c/ S.r�. <br />q�'YN 110. eI— <br />3//2 <br />W ///7 rt � nr r1 s , 6�P �: Sryp/o / / rt /r // / m M t /'/ i•�t . <br />tCi✓►,h 1J6i tY S IV,.// 6;77 /Q 60 / lLq cr/ /H I•Iva�7/IY6✓ <br />/2///�1U rr .('/�`/r <br />o' ee //,P]�J/1 <br />-7 3 r 5.1. u- O pl' LV Ur►`- IS to v+-�O/IG�r (� <br />3 F3 <br />t /N atN.: .�/a/! w�J-lI tLtrrCnr "7 ai' �u <br />Tne undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims lot damages. Coale, <br />espentea or causes of action that may &If" because of Installation <br />and maintenance of the Improvemunt or other rlghtc4way use <br />hereto applied lot and further agrees to remove same upon notice <br />from the City and tqace p,rbllc property damaged thereby. <br />LlS <br />,s <br />A AS CON UCT ATE SI< <br />PERMIT IS VA D FOR 1 YEAR pOST ON <br />EXPIRATION <br />a_3.- g1 _ JOBSITE <br />� <br />OF CIbNDITIONS <br />CALL FOR INSPECTION <br />259.8811 <br />24 HRS. BEFORE CONSTRUCTION <br />-1 <br />J <br />-1 <br />I <br />J <br />L. <br />J <br />