Laserfiche WebLink
everctt APPLICATION FOR PUBLIC WORKS PERMIT <br />� TYPe or Print cleirlY wilh ink <br />PRESS HARD - YOU ARE MAKING COPIES pERM1T NO.�`� ��t U <br />PUBLIC WORKS <br />EVERET7, WASHINGTON i BLDG. DEPT. NO.— <br />�'(�WNER ❑ AGENT DATE -� �"�"L `�L <br />APPLICANT/FIRM R��NTED _� D_ rS L� _� O l�C _� S O�% __ <br />ADDRESS"S� DC�I�''� �✓� CITY Gf���`'�r TELEPHONE 3SS --�D�� <br />HEREBY APPLIES FOR PERMISSION TO <br />0 <br />ATTHE FOLLOWING LOCATION <br />✓ e /'�t� / t`� �Ii d� C i 1}� 7�r' oPF r TJ� /�i <br />Attach five (5) copies of preliminary plans tor 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. No arrow�j <br />`� �C'�✓ ✓ .7�'s-C��ab��-t� <br />Signature ol Applicant <br />coNo�TioNs: PUBLIC WORKS PERMIT <br />�.J �' � �� � I �� t: .v � -'.. � c'' x1 S T"� n \ ,':: �. / <br />. ! � . �� � <br />��.,��:<� ,,:�-�� �.,,_l ' -��� �,�`��/�° <br />-� , / �><:,��- �� �� <br />�Z. ,^�.� r `�Ctu '�" /1'lti3� �i�C r� / <br />�•• -1-���1.. <br />..;. ,/7 `✓i-..i�i /l 1 .. . �/ <br />:��rr', � .r� �''I <br />;. <br /><<.: < � c/ � �•- <br />1 <br />_ �j�/ ,� <br />, ., u � l- L. � : <br />.......:....:... � � <br />�(' ,Y1.:;q 7�.^.�i�'i: a l� �.S:r:(//r/ f�'�1+�` ��� <br />/ ' � � :� <br />��/it�. i�il� /ii�� � J�"r f .'S 1'., <br />-, � „ ; �. � -,�,s �,,, � C �i <br />/ <br />('.�7 '�.'J � .> <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />�z-- <br />l�e undersi9netl owner hereby agrees �o hold and 6ave hermlees <br />Ine City ol Everett Irom any ana au Waims Por aamepe0. coste. <br />expenses, or wuses ol action Ual mey arise becauee of ineq:htlon <br />antl maintenance of ihe improvement or ol�er riphhof-way uei <br />he�eto aDP�ied tor xnd furt�er agrees to remove seme upon nollca <br />Irom ihe Cily an0 lo replace puDlic property dema0e0 thereby. <br />ACKNOWLEDGEMENLOF CONDITIONS <br />� . <br />� <br />_ : �� ;. � / , Y � <br />\BIG ATUREOFAPPLICANT � DATE � <br />CALL FOR INSPECTIDN <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />� <br />