Laserfiche WebLink
— � <br /> _ i <br /> � <br /> r '� <br /> � <br /> . <br /> — ____. I <br /> � <br /> �n ppPLICATIOW FOR PUBLIC WORKS PERMIT <br /> � iype or orin;cleady wiN ink a-� ' � <br /> PRESS HARD-YOU ARE MAKING COPIES pERM1T NO. � e� <br /> r pUBLIC WORKS ^� BLDG.DEPT. NO. '3 3� ` <br /> EVERETT,WASHINGTON i _ � V <br /> J � <br /> ❑ OWNER ❑ AGENT DATE � (� 1,�� <br /> CCI,l�l/-�JC4�/�^"�'��t,�� <br /> APPLICANT/FIRMREPRESENTED � � :q5-c�_�� 7� <br /> U [��J�___TEL�PHONE v� <br /> J� CIT' <br /> ADORESS C� � r � <br /> � G..ti �.ti���i,�.�..C�� �j..��. O ��— <br /> HEREBY APPLIES FOR PERMISSION TO , <br /> ��� '-�a /��1 � ti'=�, r��.� � � T_S <br /> ATTHE FOLLOWING LOCATION <br /> ��3 / �a-t-,^-z� <br /> Attach five(5)copies of preliminary plans for proposed work Draw lo scale and show the(ollowing as applicable: <br /> • Property lines and street identity. 'Topographic changes requiring cuts and fills <br /> other than normal foundaticn. <br /> ' Outline and dimensions of existing and . On-site drainage systems when reyuired. <br /> proposed structures. • Erosion control methods when required. <br /> � Existing and proposed utilities. . No h a ` W � <br /> ' Centerline of abutting right of way. � , <br /> � � <br /> ipnetura ol APPlicant <br /> PUBLIC WORK PERMIT <br /> CONDITiONS: <br /> � . . . . . . . . . . . . . . . . <br /> + . � . . . . . . . , <br /> ; _; _1 _ . � . . . � . . . <br /> . : . . : � . - j � • � • i � ' __ ' _ ., _� , , ._ ___. i �-- - - - <br /> � ' j <br /> � '_ _ �����; ._ ___—•--•-- �� ` . . _ _ . . : ._. � � . . <br /> � : ----} . — • : - . 1 j ; i . ' • . <br /> � __ � .�' - � � � � -- ' _.__�__ _l _�r� � -�----- <br /> ' _ ��� . . i� . . . � . . . � . . ; ; <br /> — — . . . , - • 'J <br /> 1_',----- �-- , .: . . � � . � . �4 . . <br /> _}.:_ _:� _ -- -- <br /> , _ +-_ . . <br /> . . , . . . <br /> -r ; ; <br /> , • , i . . ; ; . . . � <br /> . . . . a : f �. . . } . . . t . . : , <br /> � . ..� ��_yt�___...__--...— -- � ' � The undersigned owner hereby aBrees to ho�d anC save harmlens <br /> � � , , , , . . . � ��e Lity ol Everelt Irom any ena ell claims �ar Aamepen, coela, <br /> - � � ' ' � ' ' � e�penees,or causes ol actmn t�el may eriee beceune ol ins�ellation <br /> � ' � - and meintenance ol ihe impmvemen� or other riqM•obwey uee <br /> ' � � � �e�eto epD��ed lor and IuAher xgreea lo ramova neme upon nolice <br /> . . . . . . . . � + ' � � , Irom Ihe City anC lo rep�eco puDlic proVa�Y dameqed �hare6y. <br /> J <br /> L �" �"%Jo-f-3 <br /> DATE A�NOWLEDG MENT f CONDITIONS ' <br /> PPROVED FOR C STRUCTJON � <br /> . � ' _ � : _e_� "� ' — ,�� - �� <br /> _ � =. , ;,,,�,�� >'_ ;�.�-� — , <br /> DATE SI, ATUFlE OF APPLICANT DATE <br /> APPROVED AS CONSTRUCTED CALL FOR INSPECTION <br /> PERMIT IS VALID FOR 1 YEAR pOST ON 259•8811 J <br /> JOBSITE 24 HRS. BEFORE CONSTRUCTION <br /> EXPIRATION <br /> L J <br />