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I <br /> 0APPLICATIC . . FOR PUBLIC WORK„ PERMIT <br /> Type or print clearly with ink <br /> PRESS HARD -YOU ARE MAKING COPIES PERMIT NO. <br /> PUBLIC WORKS BLDG. DEPT. IN 0. <br /> EVERE TT.WASHINGTON <br /> IJ OWNER t I AGENT DATE <br /> APPLICANT/FIRM REPRESENTED _ 1L1e–���'+�-�'–f!+</�'R — -- _ <br /> ADDRESS - Gf, CITY TELEPHONE6 <br /> HEREBY <br /> IAPPLIES�FO�R3PEERMISSIONTO ���� �---� <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. Tcpographic 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 /> • C 'nlerline of abutting right of way. North ar <br /> i <br /> gkrk P011caof �- <br /> CONDITIONS: PUBLIC WORKS PERMIT <br /> VIA 1 <br /> 'UPJ 6 V) f[ <br /> V <br /> Tie undersigned owner hereby agrees to hold and save harmless <br /> the City of Everett from any and an claims for damal costs. <br /> expenses,or causes of action that may arise because of installation <br /> and maintenance of the Improvement or other right-of way use <br /> hereto applied for and further agrees to remove same upo, notice <br /> from the City and to replace public property damaged thereby. <br /> A------------ <br /> PPROVE' FOR CONSTRUCTI N DATE <br /> - ACKNOWLEDGEMENT OF CONDITIONS <br /> APPROVED AS CONSTRUCTED DATE SIGNATURE OF APPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259.8811 <br /> JOBSITE 24 HRS. BEFORE CONSTRUCTION <br /> EXPIRATION - <br />