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":!; <br />�-:: :: <br />��. . <br />;�-,:� <br />,,,; :�� <br />�::.�:� <br />�...,'}, �. <br />�,:! �5: <br />��� r <br />=z-, <br />�everett APPLICATION FOR Pl1BLIC WORKS PERMIT <br />TYPe or Print clearly wilh Ink <br />PRESS HARD - YOU ARE MAKING COPIES pERM1T NO. � Z^� � <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DFPT. NO. ��7 <br />❑OWNER �AGENT DATE ���'�r_I9�� <br />APPUCANT/FIRM REPRESENTED ,J �S L ,6.�'_a/�d � `� _ 1,1� 5 /� /� � <br />ADDRESS _��� S" S`l. 3��1�_�j�"jfj'c�'J� /.SI�NCITY T'cLE"HONE <br />HEREBY APFLIES FOR PERMISSION TO —_ U jfL /L� j� s�� j�� �,� �� d/�t GJ A YS' --' <br />c c� �n�er�ar C v�+octel <br />AT THE FOLLOWING LOCATION ?/V 5���� � �.L� �2��e���Y���O <br />Attach five (5) copies of pr2liminaiy plans for proposed work. �raw to scaie and show the following as appiicable: � <br />* Property lines and street identity. <br />* Outline ard dimensions of existing and <br />propo�ed structures. <br />' Existing and proposed utilities. <br />* Centeriine of abutting right of way. <br />PERMIT IS VA <br />EXPIRA7BON <br />FOR 1 YEAR <br />' Topographic changes requiring cuts and fills <br />other than normal feundation. <br />* On-site drainage systems when required. <br />* Erosion cor,trol methods when required. <br />* Noith arrow <br />i�ERN91T <br />The untlersigned owner hereby agrees to holtl and save harmless <br />tho City of Everett irom any ana au c�alms lor damnges, costs, <br />expenses, or causes o; actlon Ihal may arise because ul instellation <br />end maintenance of the improvement or other right-oFwxy use <br />hereto applied lor and lurther a9rees to mmove seme upon notice <br />Imm the City antl to replace public property damaged Ihere6y. <br />�`/yL <br />\� ACKNOW EDGE OF C NDITICNS <br />- Z 7—l`�v � ���Z-C.�r <br />\TE �C�NATURE�OFAPPLICqNT �� DATE <br />— POST ON � CALL Fl`�R INSPECliOM <br />JOBSiTE '�'59-8811 <br />24 HRS. E3EFORE CONSTRUCTION <br />