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<br />everett APRLICATION FOR PUBLIC WORKS PERRAIT
<br />I � Type or print clearly with ink
<br />i PRESS HARD - YOU ARE MAKING COPIES �� �2 (
<br />PERMIT NO. �
<br />� PUBLIC WORKS
<br />i EVERETT,WASHINGTON 4/16J02
<br />❑ OWNER ❑ AGENT DATE
<br />Arne H. Liaden
<br />82/10455 �
<br />BLDG. DEPT. NO. 'i
<br />APPLICANT/FIRM REPRESENTED
<br />F.verett 153-2466
<br />7n16 Lower Ridge Road C�Ty TELEPHONE —
<br />ADDRESS
<br />HEREBY APPLIES FOR PERMISSION TO
<br />Construct ca;rport of exisLing concrete slab
<br />AT THE FOLLOWING LOCATION
<br />7016 Lower Fidge Road
<br />Atiach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable:
<br />� Property lines and sireet identity.
<br />' Outline and dimensions of existing and
<br />proposed structures.
<br />* Existing and proposed utilities.
<br />* Centerline of abutting righ? of way.
<br />LI
<br />� Topographic changes requiring cuts and fills
<br />other than normal foundation.
<br />* On-site drainage syst�ms when required.
<br />' [rosion control methods when required.
<br />' North arrow
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<br />Signalure ol ApPlicant
<br />KS PERMI'T
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<br />C.ONDITIONS: _ _ _ . _ . _ , . ;
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<br />_.._� �.""" � The undersigned owner here6y agrees to hold and save harmless
<br />. � - .. ,. !( the City ot Eve�ett irom any nnd an clalms for damages, costa,
<br />I,.. � �: �; '' i :'' .�. , expenses, or ceuses of action ihat may erise because of Instellatlon
<br />4 !• ��� �� ond meintenence of ihe improvement or other riBhPoi-wey use
<br />V--. _-• ' .� I/^ � 1/� � .. ' Irom,the Ciry aod to replacoePubllc,ProPerlY dama9 d �her�elby. II
<br />/ �
<br />PERMIT IS
<br />�
<br />EXP4RATION
<br />DATE � 2— ACKNOWLEDGEMENT OF CONDITIONS I
<br />J- �� :(:
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<br />— SIGNATUREOFAPPUCANT DATE �
<br />CAL�. FOR INSPECTIUN
<br />POST ON 259-8811
<br />JOBSITE 24 �RS. BEFORE CONSTRlJCTION I
<br />_ - --
<br />FOR 1 YEAR
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