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+1 <br />everen APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with Ink <br />PRESS HARD • YOU ARE MAKING COPIES 2 2 <br />PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON <br />❑ OWNER rAAGENT DATE BLDG. DEPT. NO. _ <br />APPLICANT/FIRM REPRESENTED_(ZhIMtky <br />� <br />ADDRESS -t0Z-j 1 3 2 HO CITY fesQW&ejaTELEPHONE 113� <br />HEREBY APPLIES FOR PERMISSION TO l;r2Af.' rAE:K IirV P-T1.erj Q (u Lp�i _ (tJA.I 1An1Z lr <br />AT THE FOLLOWING LOCATION 751 SW 5- <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />I <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-si� drainage systems when required. <br />• Existing and proposed utilities. • Erosign control muthods whn required. <br />• Certerline of abutting right of way. • Noathrrow n <br />PU <br />CONDITIONS: <br />I. NO ofevv c.IH I" DY IL04%- Avr V, r. u ,, <br />.CK cau a..�tov. .fir �tn.r r•J' %o \v\a�wl <br />Alit 04�rfr vi,V.i.#7 G.rosel.y� w.t1 be <br />.ia.Closx.,o� oq QC.Ita?� I�lac w be�wees <br />Qwrrlcaa�rt hU&JI, Ipc Pace& CA,. <br />ftl <br />t b! allow..X I ex. arf lr �or <br />I-154- CL?frctur✓,. <br />'04 e-9-- t'k 6I0 cl, QMaQ <br />P OT 4* v 614t L~k% -7-M V, <br />over IbA�' VA%A?.V le< Ma,n•l,wrwry. <br />works =. Slre.lro- <br />Exce�ro� a-1-/ -ev w\\ wo 1� <br />ap vr <br />�sa5/1rr}/d t1�f«s —bid <br />8 — <br />1'72.0 <br />9 - <br />I b 2- O <br />to - <br />ISao <br />it - <br />Iq io <br />It— <br />%S <br />83-6j <br />13- <br />%LLD <br />� ROVE FOR CON�CTION <br />ATE <br />DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />be Per Pla, s <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims lot damages, cost% <br />expenses, or "uses of action that may arise because of Installation <br />and maintenance of the Improvement or other fight -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 <br />POST ON I CALL FOR INSPECTION <br />259.81311 <br />rJOBSITE ST <br />24 HRS. BEFORE CONSTRUCTION <br />J <br />