Laserfiche WebLink
erett APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYPe or print cleaAy with ink <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. � � <br />PUBLIC WORKS <br />EVERETT, WASHINGTON / BLDG. DEPT. NO. <br />�OWNER ❑ AGENT DATE _S=' '�,� �� _ <br />APPIICANT/FIRM REPRESENTED �L11/�'� �. v��S�. <br />� <br />ADDRES:: ���� C� y�/�� C �( L/1�• CITY ''��� TELEPHONE ^'-� �,� SZJJ' <br />HEREBY APPLIES FOR PERFAISSION TO v`G E--,(/s�� ��r��G�l-c7 _ <br />AT THE FOLLOWING LOCATIUN <br />P.ttach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />* Property linPc; and street identity. * Topographic changes requfring cuts and filis <br />' Outline and dimensions of existing and other than normal foundation. <br />proposed structures. * On-site drainage systems when required. <br />* Existing and proposed utilities. ' Erosion control methods when required. <br />• Centerline of abutting right of way. ' North arrov✓ � <br />/ <br />�M!�' � �� �� r�•a � <br />L�'�"��� gignature oi Applicant <br />coNoiTioNs: PUBLIC WORKS P'ERMIT <br />��jJ <br />i'_ � � <br />i 1� <br />�C�C/!'1- <br />���� �� <br /><< ����� <br />. _. . � �f�C� ���/� . <br />E <br />�j/L� ?�j/ �c�M/'� ��'`� <br />.:_._. . .�....}_, . , ,._.:. <br />RERMIT i� VALID <br />EXPIRATION <br />�� ���� �% <br />�2r-t C� %/�'� i <br />C%r� c%C i,. •�/.S' �r�' <br />�� / / <br />� .� i <br />_ � , <br />_ �.. :' _ ! <br />' r� � <br />�� � 'T. <br />� � � <br />' � r.: � <br />.., a :_. : _ _. <br />,_j _._ � .._7...:. The undersigned owner hereby aB�ees to hold and save harm�ess <br />,.r...... .�._ . the City oi Everett irom any antl au claims lor demeqea, coat& <br />�-- -.--�—� , � expenses, or causes o� aclion thal may arise because ol Instelletlon <br />-�-- -•�'�- and mainlenance d the improvemen� or other riBhPoFwey use <br />�� � -� hereto applied for antl lurther u8�oe5 to remove same upon notice <br />Irom t�e City antl to replace Oublic property demeBetl theratry. <br />���A�/ /7 o i� <br />--�'�+- - �J JG� <br />_ ACKNOWLED EMENT OF CON ITIONS <br />� t � <br />� I��G/%S Z' / /i.,,n � • ����� <br />� a—_ <br />DATE � Gf� T OFAPP A1 L"� D — <br />1 YEAR <br />CALL FOR I[VSPECTION <br />POST ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />_� <br />