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06APPLICATION FOR PUBLIC WORKS PERMIT <br /> Type or print clearly with Ink ,Q <br /> PRESS HARD -YOU ARE MAKING COPIES PERMIT NO. 8" <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON BLDG. DEPT. NO. <br /> ❑ OWNER ,_AGENT DATE <br /> APPLICANT/FIRM REPRESENTED & -- -_ - . — <br /> �'� 1 37/7 x, PZ c2J <br /> ADDRESS .– OITY TELEPHONE <br /> - - �. <br /> HEREBY APPLIES FOR PERMISSION TO <br /> AT THE FOLLOWING LOCATION �/ 7�� 1 ! 2 <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. 7Nortrow igna urecant <br /> PUBLIC WORKS PERMIT <br /> CONDITIONS: <br /> I , Pk6Qi0:C A Rpt-l6VA6LC— 66VE9, FOR, THE <br /> jAr1.11t-AfR�{ 5C-t,WEtL Wl' t� ruCt_.C. SL)CrA,tsLIG <br /> TU �(Zc�,ltD� ACLC- 5 Tb `rHIr PvM R <br /> 2 mob( ATE 'rHt YARD So A-5 JZ <br /> �Z e-.CINFLIe-T• w)*TH ACCESS Tr-) TNt= <br /> cL.l T_ WELL <br /> —agrees to( kZ., " <br /> CEJ . / rel netl own r hereby egraee l �d er a e e <br /> � Y ,J-/r-Ir the City of Everett from any and an claims Im damages, coal <br /> l r� /i 1� IGF <br /> tom( / , r• �� \ expenses,or causes of action that may arise because of Installation <br /> Y ` �J +� 1 and maintenance of the Improvement or other right-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 /> cLL <br /> A ROVE F CTIONDAT ACKNOW GEMENT OONITIONS A <br /> E- u <br /> SI NT DATE <br /> APPROVED II ON TR DATE A <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259.8811 <br /> j <br /> EXPIRATION -- <br /> JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />