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r- <br /> I <br /> everett APPLICATION FOR PUBLIC WORKS PERMIT <br /> ype or print clearly with my p / <br /> PRESS HARD- YOU ARE MAKING COPIES PERMIT NO. _O W' �73 <br /> PUBLIC WORKS 7— - <br /> EVERETT, WASHINGTON yy BLDG. DEPT, NO. <br /> OWNER I1 AGENT DATE- 0__�:� �_'p .. <br /> APPLICANT/FIRM REPRESENTED__�,,mi77� IQ!!, IdeV.f <br /> ADDRESS- S606 e� [e)'I,v CITY EJ-Wp7} __TELEPHONE 3 S3-?/6/ <br /> HEREBY APPLIES FOR PERMISSION TO GonSfjracT" e,a 31 '$( 30' POG a�c/Q, Ryr <br /> atreY e_._ 14i ho Pee <br /> "c"DA Xis41.1, vas S;da-"+ . 7eLf _. <br /> :c7 - 1S " S-I. s[ems. t✓� � 4.04t. '?F >,03 <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. • 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 /> --31g re of Applicant <br /> CONDITIONS: PUBLIC WORKS PERMIT <br /> The undersigned owner hereby agrees to hold and save harmless <br /> the City of Everett from any and all claims for dramatist, 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 some upon notice <br /> J / from the City and to replace public property damaged thereby. <br /> 7 <br /> APPRZEASCONSrTRUCTE <br /> STRUUCCION j DATE ACKNOWLEDGEMENT OF CONDITIONS <br /> APPRO`1 DATE / SI TURE©F-APPL NT DATE <br /> PERMIT IS VALID FOR 1 YEAR POST ON CALL FOR INSPECTION <br /> 259.8811 <br /> EXPIRATION - JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />