Laserfiche WebLink
Lei] <br />APPLICATION FOR PUBLIC WORKS PEAR MIT <br />Type or Print clearly with ink C <br />PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. b 3 7 <br />PUBLIC WORKS <br />EVERETT, WASHINGTON BLDG. DEPT. <br />❑ OWNER AAGENT DATE <br />APPLICANT/FIRM REPRESENTED �� V I v2 1 C{t T ✓' — — — <br />ADDRESS _ 1 7l.7 //61 vt I,(,- CITY *'r"ell ' TELEPHONE <br />HEREBY APPLIES FOR PERMISSION TO WrIt�� <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 control methods when required. <br />• Centerline of abutting right of way. • North arrow <br />signature of Applicant <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />. .._. W,0r .s�.. �.1 t ♦b L' c'o ...3 �lcG�r�1 .J). o.,r �.IQYtS . ... . . <br />:: , :::::: : � p:r-:�:rc� 10,: �..b�,� w oaks: 1�-�:ea.r•1-�-e:�k--. <br />The undersigned owner hereby agrees to hold and save harmless <br />41( 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 />L . .. . . . .- . ... - and maintenance of the improvement or other right-of-way use <br />hereto applied for and further agrees to remove some upon notice <br />J - from the City and to replace public property damaged thereby. <br />A PROVED O UC DATE 7 ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />A PROVED AS COM1S UCTED DATE SIGNATURE OF APPLICANT DATE <br />PERMIT IS VALID FOR 1 YEAR I I CALL FOR INSPECTION <br />POST <br />ON I 259-8811 <br />EXPIRATION O24 HRS. BEFORE CONSTRUCTION <br />