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everett APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON n �L BLDG. DEPT. NO.T`�-1 04 -- 1 <br />OWNER D AGENT DATE / <br />APPLICANT/FIRM REPRESENTED <br />ADDRESS FZ4 5,f, IWAV _CITY a <br />/ITELEPHONE� jr <br />HEREBY APPLIES FOR PERMISSION TO l�/as—_LV/(�� 2oye Zt Te_ <br />AT THE FOLLOWING LOCATION `-OT C ACOA5 g7 - IlD3 -73r� S�• S•W <br />Attach five (5) copies of preliminaryplans 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 of way. <br />CONDITIONS: <br />Topographic changes requiri• cuts and fills <br />other than normal foundation. <br />• On -site c:rainage systems when required. <br />�-&49 Qn control methods when required. <br />PUBLIC WORKgPERMI <br />�� � G%Li//<.Cr l IHiIS% � E' �r7 ��O ��i'c��Oti , 1•'>ti e. . <br />. t IO.// <br />� !" �/7 CyC/ rn <? S � Or . ', : ; .t n• S P_ '� �y �iC. ��, �V< GLJ.nOCC'V i// i/rJ�/f. <br />L /1' 40 <br />�_ NAC J. Als PZ 77e:& <br />MIWi� GRA/A)h6E nv 7a �V73 <br />f <br />APPfWIVED FOR CONSTRUCTION DATE �1 <br />APPROVED AS CONSTRUCTED <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />3/- 3 L <br />The undersigned owner hereby egiees to hold and care harmless <br />the City of Everett from any ano all claims for barrages. [osls. <br />expenses, or causes of action that may arise because of In! titillation <br />and maintenance of the improvement or other right -of 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 />OF );ONDITinNS <br />`II 9I TURE OF PPLItZANT - DATE <br />CALL FOR INSPECTION <br />POS4 ON 1 259.8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />i <br />