Laserfiche WebLink
, <br />everctt APPLIC/�1TION FOR PUBLI� WORKS PERMIT <br />� TYPe or Print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES pERMIT NO. �� � S U <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. NO. � 4``� <br />D�OWNER ❑ AGENT DATE S- � �- � � _ <br />APPLICANT/FIRM REPRESENiEO " °��'� �y�'maN�� <br />ADDRESS 3o F"�rq I\c-C _ CITY�_J/P�FTi 7ELEPHONE.�SS'SY17 <br />,� / i — D <br />HEREBY APPLIES FOR PERMISSIO�! TO /JVi I R(r I P�t � P 11�+t�( R�u/}DO/"'% <br />. I � .I � � / . T 1 <br />ATTHE FOLLOWING LOCATIOPi �� �e��� /�� FvP � P <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. <br />' Outline and dimensions of existing and <br />proposed structures. <br />' Existing and proposed utilities. <br />* Centerline of abutting right of way. <br />BLI <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On-site drainage systems when required. <br />* E on control methods when required. <br />. ��, �..,...� . . <br />CONDITInNS: _ . . . . _ . <br />`:�: I:, ; t�i o: '-� Nj p A C: i. c� t•� � �; �'SL_ I L 1., f�-2_) <br />, : : : : �•, : c.e,� e �,T � �u. : �� tJ et�rt.�-�. Hc�>� <br />;........ . <br />�__.--__._... ........ ..... _. <br />�. .. �.. .__ <br />�. . .. .... <br />i.;: ..;. . .;.. .... .... ,...; .... ;... . <br />. . � � , <br />, ; <br />_._____r . . _. _ <br />_ <br />� <br />; , _ , , .. _- . _ <br />. , , , ,. � <br />t • I � � ' I • • � . . r . . . , . . . <br />_ . . . . .. . I . a..� ._��� ... �.�—�y�—.�_ _... �. «��.._ .—__.. . y ...— . . ��: �� �.—._. . _ . <br />. _ . . . . ' . . . � . . . i .T.—I . ` . . . . . <br />. _ __«_ ..1 .�_ �. .��...._� '...... . . . <br />I_• . . • . . i . . � . . . • . . . . <br />� . . . , . . . . . . . . � . . - . � <br />�.—.-�.r-•---�--!.-.�---��_�_.__--... .. _. _ .. . _ _ . . <br />. . . : . . . . . . . . . The undersigned owner hereby agrees lo holtl and save harmless <br />� . . , � � , , , , , , , , , , , , , the Cily of Everett trom any ana all clalms for demepes, costs, <br />, . . . ; . . . , . � � � � � � - expenses, or causes of action that may atlse becauae ol inetallatlon <br />. .. ... . . .... . . . . . . . . . . . . . . . . . . . . and main�enance of �he improvement or other righFol-way uae <br />. - . . . . . . . . . . . . . . . . . � hereto applied lor and turther agrees to remove same upon notice <br />.._ . .�/ ��// f � � trom ihe Cily and to replece public property dama9ed thereby. <br />"f/ // <br />��� , � �_ <br />fE <br />� � —6 �_ <br />G �- <br />qPPROVED AS CONSTRUC� <br />PERMIT IS VALID <br />EXPIRATION <br />1 YEAR <br />CONDITIONS <br />S-.�(!n, `- <br />� CALL FOR INSPECTIO�N <br />P ST ON 259-8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTfON <br />