Laserfiche WebLink
everett AF�PLI�AT60N FOP /�UBLIC WORKS PERMli <br />� TYPe or Prinl ciearlY wilh Ink � <br />PRESS HARD - YOU ARE MAKING COPIES `� l `� <br />PUBLIC WORKS PERMIT NO. � ' � <br />EVERETT, WASHlNGTON BLDG. DEPT. NO. <br />❑ OWNER ❑ AGENT DATE �� " � Y <br />APPLICANT/FIRM REPRESENTED _ �,�V�i O /✓/� � %Z �F <br />ADDRESS � � �V� CITY 1-rC � TELEPHCNE <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />- l-On s <br />� <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br />* Proparty lines and street identity. * Topographic ctianges requiring cuts and tills <br />* Outline and dimensions of existing and other than narmal foundation. <br />proposed structures. � On-sit� drainaye systems when required. <br />' Existing and proposed utilities. � Erosion control methods when required. <br />* Centerline of abutting right of way. � North arrow �— <br />��1�=u-� ��iY ✓" e-�-rcC_� <br />Signat6re o ACP�icant <br />PUBLIG WORKS QERMIT <br />CONDITIONS: <br />�...._, <br />. . : : : � i . ' . ' . . . _� _. : : , _ <br />� � �-1--�_:__}-_-:.�_'. : .. .� ��. <br />1 `, <br />,.,,.:� ....:. . . <br />..-• -- -i�__ ,.._.--} <br />� , <br />: : : �_�� �-�_��-� :�-;__:_�_:_�_�-- - --: : . _. . . . <br />.......... .... ......:. <br />; ::::: ; �:,, : , ; <br />______. __. _ �___ _j _ _. . , . <br />. . . . . . . . . . . . . . . . <br />. . . � . i� i" . <br />�' <br />PERMIT IS VrCLID <br />EXPIRATION <br />1 YEAR <br />-.�.� - �3 <br />The undersi9netl owner hereby agrees to holtl and seve harmless <br />Ihe City ol Everelt imm any ana au ciaims for demaees, costs. <br />expenses, nr causes ol aclion lhat may arise beceuse ol installation <br />and maintenance oi the Impmvemenl or olher rigM-obway use <br />herelo applied fof and lur�he! 0Bre85 Io remove Snme upOn nOliCe <br />irom !he City and to replace public p�opn�y damagetl thereby. <br />��'� L. <br />� ACKNOWLEDGEMENT O�F N 4�A�ON9--'-" <br />Ll'� �i'�:�� i:f ,�-�Y._�t%-E'/ . <br />51 ATUREOFAPPLICANT DATE <br />PO,�,T ON CALL FOR INSPECTION <br />259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTION <br />� <br />�` <br />� <br />� <br />.1 <br />I <br />