Laserfiche WebLink
r <br />� <br />L <br />�----------�- ---____. . <br />f� � � - 3�" i,... -'�w,-.,.1 <br />�f? r w, i i --� <br />1 <br />"'°rc" ' APPLICATION FOR PUBLIC WORKS PERMIT <br />e TYPe or Print clearlY with Ink <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. ��' / S � <br />PUBLIG WORKS <br />EVER�IT, WASHINGTON .'/ BLDG. DEPT. NO. — <br />�'OWDIER OAGENT DATE -s/�� 8Z <br />APPLICANT/FIRM REPRESENTED T�BMA1 .E'• ✓A�/ I�✓yC%' <br />l S5 -.T / E 5� G+ <br />ADDRESS 3830 GEoE.eAG �t/E CITY ��f�« TELEPHONE ZTz �22v-p N <br />HEREBY APPLIES FOR PERMISSION TQ <br />l <br />AT7HE FOLLOWING LOCATION �B�'�� <br />GL /�o%�TiC�v oF C-c� /I <br />Attach five (5) copfes oF preliminary plans for proposed work Draw to scale and show the followfng 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 />� Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-site drainage systems when required. <br />• Erosion control methods when required. <br />* Novth arrow . ,� <br />PUBLIC WORKS PERM <br />(CQNDITIONS; . — _ _._ _ _; . _ _ . _ _ . <br />j 1..No.brush clearing is permitted within 60' of drain pipe as shown on sketch. <br />l_. _. > . . . . . . . . . . . . . . . . <br />E2. ., P.ermit for fill is for a maximum of 500.yd3 to4a1. Applicanf recognizes there are approximately <br />�..�50 yd3already placed, which.fhen.allows no more than 450 ydj addifional. � . �. <br />�9 �.Applicant recognizes that �current fill will be placed in an uncompacted state and wili be.placed � <br />j. .over.orgamc material. Should the area be proposed for a Public Right-of-Way with future land <br />_... . . . _._ . . . . . . . . . _ . . . . . . <br />....develapement, the City will requue that the fill be certified by a qualified soils lab to be s4able <br />....and sufficiently compacted to alleviate future settlement. <br />4. . Applicant is informed that no further .permits for clearing or filling will be issued, for this <br />', � �. proper.ty prior to completion�oi a full S.E.P.A. �CV1BWde undersigned owner hereby egrees to hold and save hermless <br />�� , . ihe City of Everett trom any ana au clelms lor tlamapee, coeta, <br />� � . . . � . . expenses, or causes of action thet may arise beceuse of Inatalletion <br />', , , ,,, , , , , , , , . . . . . . . . - . . . . . • - . and maintenence af the improvement or ot�er righ4ot-wey uae <br />. . . . . . . . . . . . . . . . . . . . . hereto aOPlied for and further egrees to remove aame upon notice <br />.... .. y � � - fmm the City and to replace public Oroperty dema9� ��ereby. <br />��� /��� f— �' '�— <br />O C O N S � U C T� 0 TE ACKN�LEDGEMEdTO�ONDITIONS � <br />� ���/ ,/ i � ~ � / " <br />�lj (,.1 %6�" 9- %-�3 .,; ��/�v,. ig^ � <br />APPAOVED AS CONS RUCTED DATE SIG AT RE OF APPL CANT DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPI RATION <br />CALL FOR INSPECTION <br />POST ON 25g.gg� 1 <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />