Laserfiche WebLink
everett pppLOCATION FOR PUBLIC WORKS PERMIT <br />e <br />PUBLIC \NORKS <br />EVERETf, WASNINGTON <br />❑ OWNER ❑ AGENT <br />Type or print c�eerly wit� ink <br />PRESS HARD - YOU ARE MAKING COPIES pERM1T NO.�"2 �c 2"` <br />DATE G/�`? � �'--- <br />n <br />APPLICANT/FIRM REPR�SE�TED <br />� <br />BLDG.DEPT. <br />ADORESS S`�r` S-�,c�{_ S��GV�Ns �.�• , ��Ty���G S�e./+�_TELEPHONE 33� 3Gp3 <br />HEREB' APPLIES FOR PERMISSION TO <br />ATTHE FOLLOWING LOCATIOP� ���� �^ �u"1 y'J � <br />Attach (ive (5) copies of preliminary plans for 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 />Y <br />� <br />0 <br />:_ <br />' Topographic changes requiring cuts and fills <br />other than normal foundation. <br />` On-site drainage systems when required. <br />• Erosion control methods when required. <br />` North arroW-� „ . i / <br />PER <br />1 _ _ ' The untlersigned owner hereby egrees ta holtl antl save hermlese <br />� � ~� iha Cit oi Everelt tmm any ana au cialme for tleme0es, costs, <br />..i--1_� ..1 —�--- _�_•__ _'_i_�_ Y <br />eapenses, or causes ol ectlon Ihet may arise becausa ol inslallallon <br />��� I I '� entl mainlonance ol �ne imDrovement or ol�er tlp�4o4way uae <br />��. — �. +— ���--•- ^�-r-i— �erelo applied lor antl luriher agroes to remove s�me upon notice <br />-i --{ -r�- 1 Irom Iho City antl lo replace public propetly tlame0ed IhereDy. <br />_ _ 1_"L_ <br />' /� /'6 �- <br />U TION �'z7��� OWL E��F�De�� � <br />� <br />�� y <br />CTED DATE SIGNATU OFAPPLICANT DAT <br />PERiIAIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />POST ON <br />JOBSITE <br />CALL FOR INSPtt. i ivrv <br />259-8811 <br />24 HRS. BEFORECONSTRUCTION <br />.� <br />