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APPLICATION FOR PUBLIC WORKS PERMIT/ <br />Typo clearly with <br />PRESS HARD YOU ARE MAKING COPIES PERMIT NO. <br />PUBLIC WORKS <br />EVERETT. WAS; <br />HI/N9Tp N � BLDG, DEPT. NO. <br />❑ OWNER LYAGENT DATE �fL- <br />APPLICANT/FIRMREPRESENTED <br />ADDRESS 7• 3 �Y CITYi'�� TELEPHONE2 <br />rgw1-4u <br />HEREBY APPLIES FOR PERMISSION TO t_c::lVENn� L,{31_NC FE_ YIF "7a <br />AT THE FOLLOWING LOCATION 7 -a E e <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 fills <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. • Erosion control methods when required. <br />• Centerline of abutting right of way. North arrow <br />•_ �-t- Signature of Applicant --- -_--- <br />CONDITIONS: <br />PUBLIC WORKS PERMIT <br />PICA V s q�(,rov•D 3- .23' e L <br />as C�u//��� 6 6 L N e r 5 e r_,4 I :, w, H: b. ...:. . <br />-� rew ovf-.Q a,cC reolair^e...c� 7 aY.c_Q t1S � Sa cw-- <br />mr. rc^v-o,-.D '4� nrae r34- 4?Kf6;trn510 f <br />kvtuc tN` o <br />.. as is ;,,, W 1, w� w is E .6 e ' re P--o a-r! hy <br />.......... .. bask full <br />_.. �iPC IONS � �Q. /JOwrPv <br />PERMIT IS VALID <br />SOw 64 Nl.4 Or <br />nto s.riPc�sllc <br />Wck . <br />The undc'signed owner hereby agrees to hold and save harmless <br />the City of Everett from any and en claims for damages, costs. <br />expenses, or Causes of action that may arise because of Installation <br />and maintenance of the Improvement or other right -oh way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace puhllc property damaged thereby <br />_ t <br />3- F Z - <br />E JCKNOWIEDGEMENT OF CONDITIONS <br />IGNATI EOF APPLICANT — jjj DATE <br />)R 1 YEAR CALL FOR INSPECTION <br />POST ON 1 259-8811 <br />AORSITE r,A I I M nr_I--n nr r•n\I 0T01 1r` r1 r% w1 <br />-1 <br />