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everett APPLICATION FOR PUBLIC WORKS PERMIT <br />'1 <br />type or I rinI clearly with ink oc <br />PRESS HAND - YOU ARE MAKING COPIES 170 <br />PUBLIC WORKS PERMIT NO. <br />1El E'VERETT, WASHINGrON Xel <br />FD OWNER AGENT DATE 3 � 8'BLDG. DEPT. NO.� <br />APPLICANT/FIRM REPRESENTED -uS Alornes _Z� _ //l <br />ADDRESS �&I- U/►('y g?% SSE, El/6ff67T .—CITY EV— FT% _TELEPHONE '3� `'f,'� 7Z <br />HEREBY APPLIES FOR PERMISSION TO IAI. l- CPS / W/OE e&7Qe f_1e_ QA9�111EZW)1'1 <br />AT THE FOLLOWING LOCATION COT 7917 P'''�t0L45_ 66747&S.'6/0 73 rd 54-. S,W, <br />Attach five (5) copies of preliminary plans for pro posec' 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 struLhires. <br />• Existing and proposed utilities. <br />• Centerline of abutting right of 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 />• orthW41 <br />cant _.— __._._— <br />PUBLIC WORKS PER <br />CONDITIONS: <br />Ii 1v 0o7 '-�0/7 .Ii .r.. a,�)� in..�/ brf fbn iru llr rl Ont Io Y' <br />�i. r1,71 C1440 a3 e. a.- 6reei t` T) c AV . iN ljh� <br />i ...... 1.. .O c. �:. c r, i-r.:T S . cii! e, -t5. rv., f-ru c A n .. AF7 u s <br />.r7We <br />l /,u, IL. Q•.�✓..• 71M ��rr <br />, •_r r'. C�Pa., r�� wA ela X <br />I / <br />... ... . ... .... . . . <br />ell, <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />- 7/ j <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and an clalmi for damage% costs, <br />expenses, or causes of action that may arise because of Inetallalkn <br />and maintenance of the Improvement or other right•ol•way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />ACKN W EDGE NT FCONDITIONS <br />SW.nAT0RE`OFPPLICANT DATE: <br />CALL FOR INSPECTION <br />POST ON 1 259.8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />