Laserfiche WebLink
r <br />r <br />� <br />�� <br />L <br />� <br />�eV�`"` APPLICATION FOR PUBLIC WORKS PERMIT <br />TYPe o� Print clearlY wilh ink <br />PRESS HARD • VOU ARE MAKING COPIES � <br />PUBLIC WORKS PERMIT NO. �` I� <br />EVERETT, WAiHINGTON - I �a �� <br />O.OWNER ❑ AGENT DATE _ ��/� l-'� �" ' �� BLDG. DEPT. NO. <br />APPLICANT/FIRM REPRESENTED _ <br />ADDRESS � � � ��' I � I �, <br />HEHEBY APPLIES FOR PERMISSION TO <br />� <br />,1 <br />_CITY L � �� �' � TELEPHONE -' �� � I`I (� <br />�, <br />�= i/i l l)/ f-' <br />f>Db�/ ��1� 117�� �,YI� 1 �lr� <br />AT THE FOLLOWIIvu LOCATIO�` / ��i� �� -,: ) �. � S � <br />Attach five (b) copies of preliminary plans for proposed work Draw to scale and show the following as appliceble: <br />• Property lines and street identity. <br />• Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />• Topographic changes requir(ng cuts and fills <br />other than normal foundation. <br />' On-site drainage systems when required. <br />' Erosion control methods whe �required. <br />• North arrow , <br />� � , 4������ <br />• siynxtureo�Ao �iunt' <br />RKS PERMIT <br />CONDITIONS; <br />(...... <br />; j 1 <br />( . . . . � . , � � � O O � . <� I R � .n S . M �n S 4 � Q '� � � �t � ' 1 � v� f c]t 1 -� t"O � . . . . . <br />r.-._. . . . . . . . . ��t�C 9c't.ve,r � . . . . . . . . . . . . . . <br />I, . . . a. s� <br />_:_:_: _ . �r�- . ts <,{:� b�- kN�+- cl��,,, . ��,b�„ ��,�I«�% <br />_1 j` ` �_. <br />� .. . . . .... . ..In ��t�iC� �Q.UW• Y'�lyi.S'�'� IV•P C.Lf�:..p�.. . . . .An.�. . .... <br />�l.�,i. • <br />� . . . . � . . . .1 . . . . . . I. . . . <br />� . .—... —".�: . i'[��lN(C.� . RC��'.C'�.� tcT"LI♦ CIP�1N . W{7 .5'�PF.1' . CL!'P�� <br />� . . . . . . , 1 p . . . <br />.. .. { 'wl,e., reSKe�lr�.S.'_ o��yf" %:G : �-.,�����,%,-� c�.ii i�s�if- <br />i. _ .. � � _. . . !n. . . �f/,/. . F�vc.�/ _ Ort� . plo✓ tc� Q Pi n � �[� 5 f'rc.(r; . . <br />�: :�' �P• ivo�c�� � � �: / � . <br />I • - �' . . .49�� C�(t'i)n —4S^ i G�tJ.�.7•' �t� l� <br />L-�._.,_: »...�__ ' . . . . . . . . . . . . . . . . . . . <br />i. . . . . . . I . . . . . . . . . <br />��......�..... .�.. .. . . . <br />. ... __r..�—__r_._..,_.��.r�...-4.7_._._.. . . . . <br />' ' ' ' ' ' ' ' ' ' � � � ! � � • � � � The ur.tlersigneA owner �ereby a9�eas to holtl end save hermless <br />, ; ' ' : ' ' � ' ' - � � � • - - Ihe Cily ol Everett trom any anc au cialma lor amape0. costn, <br />.� '' -'- '� � espensea, or causes al ectlon Ihal may ariae Depuee of Inshi4lbn <br />, . � ' � ' ' ' ' ' � " ' ' - ' ' � enA maintenence ol t�e Improvemenl or othor rlpAtrol•way use <br />' � ' hareto applietl lor anE lufinar aqmes to ramove name upon notke <br />Imm tha City antl to replace pu011c propetly dam�petl IhereEy. <br />� ���=-�/� <br />� Ceu�,.:,e. G�,,,,t=C . C'r. 7y,':a • <br />/� "y'3 J�_.�.__/1,�. ; ,�,6 s./'� �- 7 - <br />DATE SIGNATURE Q APPLICANT, DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />POST ON CALL FOR INSPECTION <br />JOBSITE 259-8811 <br />24 HRS. BEFORE CONSTRUCTION <br />� <br />� <br />J <br />� J <br />