Laserfiche WebLink
"'�`"` APPLICATION FOR PUBLIC WORKS PERMIT <br />e T�a o� P���� ��ae�Y �,h ��k <br />PRESS HARD - YOU ARE MAKING COPIES pERM1T NO. g, Z 3� <br />PUBLIC WORKS <br />�OW ERWASO AGENT DATE -� T�/ BLDG. DEPT. NO. <br />APPLICANT/FIRM REPRESENTED <br />ADDRESS <br />HEREBY APPLIES FOR PERMISSION TO <br />ATTHE FOLLOWING LOCATION <br />CITY,f=7�TELEPNONE �3 (J�.� <br />Attach five (5) copies of preliminary plans fcr proposed work Draw to scale and show the following as applicable: <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 />PUBLI <br />* Topographic changes requiring cuts and fills <br />other than normal foundation. <br />' On-site drainage systems when required. <br />• Erosion control methods when requfred. <br />. .� ................ <br />, <br />� <br />;,QNQITIONS; . __.r_. _ ____. ____ . _._ —_ . . _ <br />...:...� . .... ... .... .._... �.. <br />. . . , . . . . . . Gxls%ic� Ed c o� I7av� . . . . . . . <br />.:. ,II �. � �� <br />„ <br />. . � 8e'`�m_ . . . It� t-�,l 1'I2 : . . <br />, _ : ., : II .> -,�� . <br />d so�..�41, <br />, ; .�,. . f . . _ _ .. . i . <br />II , . . , . j3 ec- v.-� <br />�- . % : <br />__ . : . <br />. . . -L I . _ . . . _ � .�-_—. � __ . �e1-ra, � { : . <br />_....o II..� I._: � �.... .. . '. . ...�, � <br />__�_: ��►1 � :� .. :_ _. . ;.:.;. _. .,.: :�: <br />_.. . .� <br />;},-. : : : � �o!�.5e". : . : <br />� � ��� > . � ,� , . , . . The undersignetl owner hereby agrees to hold end seve �ermleas <br />, , . . . . .� a � . . . � : . . . . . . . . . the Cily ot Everett rrom any ena au clalms for damepee, cost0. <br />. . . . . . . . . . . . . . . . . . . . . . . . . . ezpensea or ceuses ot ectlon tnet may adse becausn of Inetdlation <br />-.. __ .. . . .. . . . . . . . . . . . . . . .. . . . . . .. . . . and meintenence of the improvemant or ot�er riphtro4way uae <br />� � • • � � � � � � - • � � � • � � � � � � � � ' � � � hereto applled for end lurthet aprees to remove same upon notice <br />��JL�� • : ; � Irom the City and to replece puhllc property demeged lhereby. <br />� t�'-3-Fri <br />� � r� � �� <br />rci <br />APPRO ED AS CONSTfiUC F <br />PERMIT IS VALID FOR 1 AR <br />EXPIRA710N <br />ACKNONJLEDGEMENT OF CONDITIONS <br />SIGNATUREOFAPPLICA!JT DATE <br />CO.�L FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24'riRS. BEFORECONSTRUCTION <br />