Laserfiche WebLink
everett APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with ink a <br />PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. <br />PUBLIC WORKS ]��� �� <br />EVERETT, WASHINGTON BLDG. DEPT. NO.aWL '."/'� <br />OWNER ❑ AGENT DATE 2�7IO-eZ. <br />APPLICANT/FIRM REPRESENTED �A) DWV-OL= <br />ADDRESS AtpZl Vlyr _/ � CCU X <br />CITY T TELEPHONE 25Z 9�y� <br />1 <br />HEREBY APPLIES FOR PERMISSION TO ! LLD W cc.G7 - T^ T71-2-210VISLC— <br />AT THE FOLLOWING LOCATION <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. * Topographic changes requiring cuts and fills <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 conVol ethods when required. <br />* Centerline of abutting right of way. * North arrow <br />Signature of <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />APPR'r0 D GR CONST CTION D TE ACKNO LED�'M NT OF CONDITIONS <br />APPROVED AS CONS UCTE ATE SIGN E OF APPLICANT DATE <br />PERMIT IS VALID FOR 1 YEAR POST ON CALL FOR INSPECTION <br />259.8811 <br />EXPIRATION '3 ����' JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />