Laserfiche WebLink
everen APPLICATION FOR PUBLIC WORKS PERMIT <br />� Tvve o� P��m ciaadr w�m iok $3 / <br />PRESS HARD • YOU ARE MAKING COPIES pERM1T NQ. f� <br />PUBUC WORKS <br />EVERETT, WASHINGTON —�. „,' I� BLDG. DEPT. NO.��� <br />❑ OWNER O AGENT DATE � ��� <br />APPUCANT/FIRM REPRESENTED _—�r �1—Lt�� �-�- - �-C��-✓�3� r � �� � O � <br />ADDRESS ' CIN �' '� ' cIEPHON� ' '�' � <br />0�.--. ��� �_'__ I � <br />' —����/S, 1���.��� <br />HEREBY APPLIES FOR PFR ISSION TO —___ <br />-�-►a.r�,�—c',��.cs��--- -- — •— - -- <br />(_ -� ���� <br />� <br />ATTHEFOI_LOWINGLOCATION ��� `� �-�F�(��--��='- — <br />Attach five (5) copies of preliminary plans for proposed work. Draw o scale and sho�v the following as applicable: <br />• Property lines and street identity. <br />' Outline and dimensions of existing and <br />proposed structures. <br />` Existing and proposed utilities. <br />' Centerline of abutting right of way. <br />CONDITIONS: <br />�• <br />L� <br />' Topographic changes requiring ci�ts and fills <br />other than normal foundation. <br />� On-site drainage systems when required. <br />• Erosion control methods when required. <br />' Norih arrow <br />PUBLIC WORKS PERMIT <br />Cvv.Si'f. cir�uC wn7 ��v.� �1@Y `-�,� �} 3p�� . <br />G � �Nrr1GJ<�.- C:.XISt119c� �_ � l- In V�f•.: � �( �v E �.�ct��' .�.fYr� <br />`T i� � i' "�L�; r, in : ((... . _:. � [:��, '.,��.; r9 'iCc_��[ �: .r �CI.•t-"'��I/ j <br />- �? �{ �:. �r � C'l.il- �' i�.1'l.� i�� liU i ��! //C�:..�r'cl . J <br />C'.i:�ir, � C.'��lC_ �l�i��i.-�� _ �_`_>ic�'c✓c'�%- <br />/_ � � �9 <br />ci��"�is •��.;�aj r t'�/� �Jt� �<�%ern%_ rNS�/�V <br />�� � :. �, �r�, S �/ �+, /YC/` . f'(�/ : ��� 3 � � �, <br />�l/� �uu/� S��r// �j� �e��.�o�:N�iLi.; e<'c•tr,.in.i�r /c�•�� 1'��,J <br />� n�/nr�7 .7..c1� C��r'ih�� iJ1� p i' F..r':[f �.%��5� f,� �i..J' C�/r iP"I�GT'/u.� <br />��� / / / / <br />:�: �.cCi�,•cl7 .:�.,1' � .:lr'cc•, �7�c .t ric;-r) . <br />The untlersignetl owner horohy ag�eos lo hold end saue hermless <br />Ihe Cily ol Fveren tmm any ana all clalms lor damapes, cosis, <br />. eFpenses, or causos ol aclion thet may eriee bocause ol Instulletion <br />. end maintenance ol Ihe imp�ovemenl or othar rlQht�ol�way usa <br />harelo epp��ed br antl furt�er agroes to rnm�ve aema upon nolice <br />� , . � Irom Ihe Cily nn� lo replac� public property uama0ed lhereby. <br />, <br />� �� �?.�, �'S <br />PE,IMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br />/ POST UN 259-8811 <br />EXPIRATION � � � �L JOBSITE 24HRS.BEFORECONSTRUCTION <br />