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everett f APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly will, Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO. <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. NO._— <br />❑ OWNE4 ❑ AGENT DATE <br />APPLICANT/FIRM REPRESENTED <br />ADDRESSf60l0 SrE C-utfittr M►+t.L LUAy _CITY ct)tofi r( TELEPHONE s�&ID2_ <br />HEREBY APPLIES FOR PERMISSION TO J1V_5,? <br />Z-)kl ve way <br />_ ldr yjy <br />AT THE FOLLOWING LOCATION 0 7Y 49 S' <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 of way. <br />PUBLIC <br />CONDITIONS: <br />K.:o ( - +-(I Arc% 3 <br />Topographic changes requiring cuts and fills <br />other than normal foundation. <br />On -site drainage systems when required. <br />Erosion cpntrol rgethods when required. <br />*North arrow : / i <br />43 <br />w, .;.'r be i., Il...i c.. <br />y � <br />.�77t)v'CD FFI C OONSTRUCTION DATE <br />i' <br />APPROVED AS G)NSTRU TED BATE f <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION 2 I3 <br />POST ON <br />JOBSITE <br />The undersigned ow nor hercby egtees to hold and save harmless <br />the Cily of Everatl from any and all claims for damages, costa, <br />expenses or Causes of action that' ay arise because of Installation <br />and m?inlenance of the Improvement or other rlght-of•way use <br />hereto applied to and further agrees to remove same upon notice <br />from the City and tc replace public property damaged thereby. <br />�UEDOE,MJr NT� NDITIONS <br />IRE b?FF A�r�11ICANT DATE <br />CALL FOR INSPECTION <br />259.8811 <br />24 HRS.I3EFORE CONSTRUCTION <br />