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1 <br /> avers(( APPLICATION FOR PUBLIC WORKS PERMIT <br /> Type or print clearly with ink <br /> PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. aZ 7 <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON BLDG. DEPT. NO. <br /> 1-4-OWNER (I AGENT DATE V!5'L <br /> APPLICANT/FIRM REPRESENTED J�n �7L.�_/� <br /> ADDRESS /V Z 77tH /'L• S.Lc7 CITY � —TELEPHONE SS" - Z&I <br /> HEREBY APPLIES FOR PERMISSION TO t-Nn —Tc, tJ G-ra) ' S Mmu GTu.2.-r' <br /> /1 �,,oPZQfA <br /> ATTHE FOLLOWING LOCATION _Ic)Z- �7 <br /> Attach five(5)copies of preliminary plans for proposed work Drew 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 17 <br /> w <br /> ----��Ipnal a of APWlunl <br /> CONDITIONS: PUBLIC WORKS PERMIT <br /> i <br /> i <br /> The undersigned owner hereby agrees to hold and save harmless <br /> the City of Everett from any and all claims for damages, cost% <br /> expenses,or causes of action that may arise because or 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 /> from the City and to replace public property damaged thereby. <br /> APPROVED FOR CO STRU TION ATE A WLEDOEMENT OF CONDITIONS <br /> APPROVE AS CON UCTED - DATE SIGNATURE OF APPLICANT DATE <br /> PERMIT IS V ID F 1 YEAR POST ON CALL FOR INSPECTION <br /> 259-8811 <br /> L 'XPIRATION JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />