Laserfiche WebLink
� <br /> everett I D 1 � � �'� 11� �� <br /> AP���ICA �ON f� PUBLIC YJORKS PERMIT <br /> � n � <br /> AP R r� � 1984 Type Or print clearly wi�h Ink <br /> PRESS HAflD-YOU ARE MAKING COPIEu pERMIT NO. � � � <br /> PUBLIC WORKS _.... __......... ............. .. ._.......... . . <br /> EVERETT,WASHI TON CITY O� [VCRET i BLDG. DEPT. NO. � ����� <br /> ❑ OWNER f�AG T �bATE �"�����'-' �3 ; /�/ � <br /> APPLICANT/FIRM REPR SENTED v �'M t-S C� RL� H� f'� v <br /> ADDRESS 2� ~ f=�' � • __CITY �veR�� TELEPHONE Zs� - 7y—��' <br /> HEREBY APPLIES FOR PEFMI ION TO �0 L '�� /�X iS %"iNC� h �'ik t- <br /> � c� p �. ,� �' .� 6 '-� ='� �' <br /> AT THE FOLLOWING LOCATION � �°�' f <br /> ! <br /> Attach five(5) opies of preliminary plan for proposed work Draw to scale and show the following as applicable: <br />� • Propert lines and street identity. *Topographic changes requiring cuts and filis <br /> • Outline a dimensions of existing nd other than normal f-�undation. <br />� propose tructures. � On-site drainage sy�cems when required. <br /> • Existing and roposed utilities. ' Erosion control mathods when required. <br /> * Centerline of a utting right.of way. ` North arrow <br /> /� /� C'IO¢�unti J��3'rr✓-� . <br /> L��� : _ — � � <br /> SI nalure 1 ADGlicant <br /> S PERMIT <br /> I CONDITIONS: . _ _ . __� <br /> C . . . . . . . . . � . . . . . <br /> l _. .__ . . . . .__, - . . . . . � ; . . <br /> I . . , 4 . . . . ; . . . . .. . . �. . . . . . . . . . . I � <br /> , . . . . . . : i : . / �tew Noua�- <br /> � . � : . t�{ . . . <br /> �/: .: � :� �—_.. ;,,- �-� ceW,a„(1� <br /> f . . . ' , � ' �i' ' . . . 1_. �Y_ � . . . . . �clf BSS rcY o n <br /> f _ . . uv : : � . r�? : � Fx,s ptix; �w�,..c,r-cfi�l ��.. <br /> � . . . � I ���,u ak 1 <br /> . . . . . i . . . . . r. _ "' � �.o �� 5L'1'r. <br /> � . . . . . . L _ � ' , . <br /> C . . .. . . . . _ ;�r bn <br /> � , . <br /> � �:�_:_: : . . . . . . . . .i<;c � - <br /> I : : : : : : : : - � :Pd ST � ` <br /> � _ . . . � <br /> ' ' "-�-'-' � � � ' � �� � � � The dersignetl owner hereby agrees t�hold and seve harmless <br /> ' ' ' ' ' " ' � � � � � . , , , the Cit of Everen trom any ana au clalms for demapes, cosls, <br /> ' ' � ' ' � � � � � . . . , . . e.penses,or causes of aclion ihet may etlse because of Inslallalion <br /> � � � � � � � � � . . . - - . . � and maint ence ol the improvemenl or other rfqh4ol�way usa <br /> ` . , , , , � _ , . . . � � � � ho�elo apP6r for end further eBmes lo remova same upon notice <br /> ! . Imm Ihe Ciry a\ ro replece publlc pwpeAy damapetl tnereDy. <br /> — y � \ <br /> e P ROVED R C ST O DATE ACKNOWLEDGEMENT OF CONDITIONS <br /> - �.-.- 1/r� �c�. .�.�) �/-��- Y3 <br /> AFPROVED AS CONSTRUCTED DATE SIGNA RE FAPPLI T DATE <br /> PERMIT IS VALln FOR 1 YEAR CALL FOR INSPECTION <br /> POST ON 259-8811 � <br /> EXPIRATION JOBSITE 24 HRS. BEFORE CONSTRUCTIOW <br /> I <br /> � _ <br />