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APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with Ink <br />PRESS HARD • YOU ARE MAKING COPIES 41-Z7 <br />PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON <br />'r. ❑OWNER I(AGENT DATE JBLDG.DEPT.NO.____ <br />APPLICANT/FIRM REPRESENTED _]}�_,_ AGO► I L <br />I ADDRESS 'LOZJ I S Z NO <br />CITY 4k4QWkAJ1Q TELEPHONE <br />IHEREBY APPLIES FOR PERMISSION TO41 G-X (A A_-rt <br />AT THE FOLLOWING LOCATION <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. •Topographic changes requiring cuts and tills <br />Outline and dimensions of existing and other than normal foundation. <br />proposed structures. On -site drainage systems when required. <br />Existing and proposed utilities. • Erosic n control methods wh n required. <br />Centenme of abutting right of way. ' No h arrow <br />sl avers nl.n <br />PUBLIC WORKS P)ER011 <br />CONDITIONS: <br />' ]. No : ope, cwH IH` o� Ib�= �t w. t1 bt RIIUWP ex c } 4 <br />eP r <br />Cxca\rtiJ4,l,,,.. (e5\.,rr..Y %i �ti�{o\11-iap�., ero53 �. .�..•�er S.��i•w., <br />6ir loorr.'r�ar ;oci <br />1..1, Clos\.x) oFi/Ioe. Ib vet w be(�wer, 15 a �(' $o�r� Ct aPrravr.�. <br />'' rp! 016 ofJ. 11 17a bi 6Io CIC a.. Q <br />-:v 1•� e 514A\ICl 4 lcl1 <br />It <br />• p� l3 <br />! -5 . it "A c < 4 \ o.: o f r'< <br />Clot. rto�� 'fF \+LP.t rra.•\{—. Ilv-. ir1% <br />�.... erg <br />EKCe 1— at MOP <br />Usti A*'S`T iclrrc3 — Did 8 — I -j i p <br />9 — 162-0 <br />10 — IS LO <br />La <br />=.0 <br />�--53 8115— lzza <br />PROVE FOR CONS CTION -` --- -"- "--- <br />ATE <br />DATE <br />PERMIT IS VALID FOR 1 YEAR <br />UVCf Ib+� ImNlf bf Mw,..I w„�.\y <br />40y3 'erVw �J �1NVr..0 <br />w\\ wo11k S6w it 6f Per (IAws <br />The undersigned owner hereby agree, to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, <br />e,penses, or causes of action that may enact because of Installation <br />and maintenance of the improvement or other right-ol-way use <br />hereto applied for and further agrees to remove rime upon notice <br />from the City and to replace public property damaged thereby. <br />OF <br />f <br />POST ON CAI_I_ FOR INSPECTION <br />11 <br />JORSITE nw uno nr_rnn9 88nuormrrrrnu <br />J <br />IN <br />