Laserfiche WebLink
1 <br /> r _ - - 1 <br /> everett pppLICATION FOR PUBLIC WORKS PERMIT <br /> � TYVe or Print clearly wllh Ink � [..— <br /> PRESS HARD•YOU ARE MAKING COPIES pERM1T NO.�'�� 1� � <br /> PUBLIC WORKS � BLDG. DEPT. NO.----- <br /> EVERETT,WASHIN TON L . , <br />• ❑ OWNER AGENT DATE S -� �� �G���C�? <br /> � �q G���r ____� <br /> APPLICANT/FIRM REPRESENTED _—!1l��� �LYns �'v��1-- <br /> ADDRESS o � � �� 9 � �,� � L _CIN 1'r S�.�--TELEPHONE > <br /> HEFEBY APPLIES FOR PERMISSION TO <br /> , _�/��'_/����'�C'-cG�f9� o�'� <br /> L �� <br /> '� jr. �% �d�["F.� <br /> qTTHE FOLLOWING LOCATION <br /> ���/ 5 �/�* <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 cha�ges requiring cuts and fills <br /> other than normal foundation. <br /> ' Outline and dimensions of existing and . Qn-site drainage systems when required. <br /> proposed structures. + Erosion control methods when required. <br /> � Existing and proposed utilities. • Nocth arrow / <br /> ' Centerline of abutting right of way. �( j =�l1'� `�- <br /> �YI�Z �� <br /> S�pnatu�e ot APPlicant <br /> PUBLIC �NORKS PERMIT <br /> CONDITIONS: - I <br /> � . {� ,� . <br /> � . . . . . . . � ..� ` ���`�����fMi . � <br /> � � � • . � . .Y 1 '1 Cr <br /> ; . . . . . . . . - ' � � �` . � o . yy � . . . . . . <br /> �i ..._—. -. . . r � R; t�` -tK-. . . <br /> '� . . . . . . � . . <br /> �. . . . . . . . , . _ � -ie—� � . . . . . . . . . . . <br /> , . . , . . ��� . . . . . � 1 - � �ir�rd- in J � L-��5 •�'iv� `. � <br /> .. _ . . . . ' l� �001 . CI(c'�.�r� $ . V.v�v� S'��. 1YJc �1�'t� . . . . . ,/. . . . <br /> � . . . . . . . . � � - jI�C . SL�...�c'r .1C.�1$r:v�. . . . . . . . . . � <br /> 1 / �n55f' => �� v+ t�c'/ 1 <br /> � . � �Q� Z � - CX�`i-1 ivt� 51[Ie. �i'wi'_ rl NC�� � 'T" <br /> �. . . . � t `• �� � .,a YH. ` <br /> , �.� � . c, q r��, Z. Cx (Pc�. :c / cr� <br /> . ro u �� I <br /> 1---_ . . _ . . . . . . . � �-�� or c.� �er�.� -�v to,. ��..... �i'� <br /> I ' : : : : ��= RI o c � r r / <br /> l 0 5�'�c'/._fi� i C'/in i� <br /> �� . . . . . . . . . . . . . . � .� . -�'r �cc � � <br /> __� . '^----#-`—'__.____ . <br /> ( � �'�t.� �ho unde�signed ownm ere6;agrees to hold and save harmless <br /> �' . , , , , . � Ihe Cily o� Everelt trom any ana an cia�ms for dameges, cos s, <br /> Y i Y , , � exDenses,o�ceuses ol eclion thet may edsa because ol InstallatVon <br /> � and mainte�ance of Ihe improvemenl o� other rlBhl�of•wey use <br /> . , . . . � � � � - ' � � . he�e�o apPlied for and furiher agrees to remo�e damepedo�hereby. <br /> , . . . . . . . . ' . . . . � � . Irom the CitY end b rePlace Public p�oPeNY <br /> _— '' ' �`� � DATE L ACKNOWLEDGEMENT OF CON ITIONS � <br /> j� p OV€D FOR CONSTRUCTION ` � � ��'j�i��" S �i�— <br /> � �=�- ` ._.'-,�I���_ DATE <br /> i � � �L ' � �� � ' � � SI NATUREOFAPPUCANT <br /> \� � ' DATE <br /> APPROVED AS CONSTRUCTED CALL FOR INSPECTION <br /> PERMIT IS VALID FOR 1 YEAR pOST ON 259-8811 <br /> JOBSITE 24HRS. BEFORECONSTRUCTION <br /> �- EXPIRATION -� <br /> � <br />