Laserfiche WebLink
everett APF�LIC;ATION FOR PUBLIC WORKS PERMfT <br />� TYGa or print clearlY wilh ink �. .., � V <br />PRESS HARD - YOU ARE MAKING COPIES PCRMIT NO. V� <br />PUBLIC WORKS <br />EVERETf, WASHINGTON BLDG. DEPT. NO. <br />� OWNER ❑ AGENT DATE �%— / — � � <br />APPLICANT/FIRM REPRESENTED ��S=�t;�__�[",�_j� <br />AODRESS �� !� ���` l� i TZ��— CITYF=�Y,`-� LC TELEPHONE •�5 5—��' �� �� <br />// • � � j� <br />HEREBY APPLIES FOR PERMISSION TC �" � l� -�t'� ���� � G�-{ � 'u � "' " <br />i". T ? �I ( <br />ATTHEFOLLOWINGLOCATION .F'-rc�'�!� %= -`.`"�'�� '— �—�h ���� � � — <br />�.. <br />C�-�.• -��e_'L< <I��-t..�'c it. CC JL 7t � J_ Z�f� � i'�`' : <br />Attach five (5) copies of preliminary plans for proposetl work. Draw to scale and show th'e fo�lowing 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 utiliiies. ' Erosicm control methods when required. <br />` Centerline of abutting right of way. ' North arrow <br />, l - <br />!j' � 'r��.-(i <br />�— �`—`�� �Signatureof'Applicant <br />PUBLIC WI�RKS PEA{MIT <br />CONDITIONS: <br />�,�. �l'� .G� X� rv� �n v� --1- i � � lJur w. �i e�eX i 5 `.J O O L, �/ _ <br />.�. � <br />; . ._._. . . . . . . . .�. . � . . ��'- � ;..--/ji`/ '•�c:c,S'/�i �. �'ci9�. . <br />��- Ar �_ 4�ir-• <br />�...�� , ... ... . <br />. . . : . � �`�r,� �- �� � <br />_ . , . . �f`:: -:_'? �. . _ . . .���' . j. �/�i�'Y �, <br />, :::: : ; �����,�� ; � <br />::-,_:_�,.-.. <br />... ;. .. <br />.. ,. .,. ;. <br />.i.. <br />. . . . . .��— <br />���"'Y�"J""'"'-^"��~���y--�—�����-+� The undersi9ned owner hereby �9�ees lo hold and save harmless <br />i. . . . . . <br />' �'''�' '' Ihe City ol Everetl trom any antl all clalms lor damaBes, cosls, <br />''' '��� exPenses, or causos ot acHon Ihet may arise beceuse ol Installation <br />� � � � � . . � . . . . - - and mninlenanCe ol Ihe improvemenl ot o�hef riBht•obway usa <br />�� herclo applied lor and luriher egrees lo remove seme upon notica <br />. . .%. . `l�'/ � -�3 <br />. � <br />APPROVED FOR_CON& RUCTION DATE <br />--�' �� �— . _ � !,� , -;-�-j <br />�APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />Irom ihe City and to repluce public pwperty domaBed thereby. <br />ACKNOWLEOGEMENT OF CONDITIONS <br />i �r: <br />SIGNATURE OF APPCICANT DATE <br />CALL FOR INSPEc i ��rv <br />POST ON 25g-g811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />