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everen APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with Ink <br />PRESS I4ARD - YOU ARE MAKING COPIES PERMIT NO. <br />PUBLIC WORKS <br />EVERETT, WASHI TON yi BLDC `APT. NO. <br />❑OWNER AGENT DATE �V 4,e/l,�,��,��;���eyl <br />APPLICANT/FIRM REPPRESENTED /v.��//L�-L f -6 <br />ADDRESS (.L.7Z '3: 4 Sl <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />E,a 3ZML(? <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />• Prop lines and street identity. • Topograi_hic changes requiring cuts and fills <br />• Outline an nSions of existing and other thar _al foundation. <br />proposed sttucl • On -site nags ystemaw required. <br />• Existing and proposed u t s. • Er of rQIJ/��e swiTpn req <br />•erline of abutting right o ay. • N- arrow' i / J <br />BLI <br />CONDITIONS: <br />360 d/3. <br />y- <br />I <br />.....:.: 71) e'.:..t a T..r /4 rtim'- <br />......... .. <br />0 <br />PERMIT IS VALID FOR <br />EXPIRATION S <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, <br />expense uses of sc:lon that may arise because of installation <br />antl r inlenanc of the improvement or other right -of Way use <br />heretb ap iad for a d lurther agrees to remove some upon notice <br />tom' the ity a� I t replace Public property damaged thereby. <br />CALL F R IN ECTION <br />POST ON 259.8811 <br />JOBSITE 24 RS. BEFORE CONSTRUCTION <br />I <br />