Laserfiche WebLink
� <br /> ' -� <br /> °"°`°" APPLICATION FOR PUBLIC WORKS PERMIT <br /> � TYPe or Prinl cleatlY with ink <br /> PRESS HARD-YOU ARE MAKING COPIES Q <br /> PERMIT NO. o'Z 3 <br /> PUBLIC WORKS / — . <br /> EVERETT,WASH/�y GTON Gy /I BLDG. DEPT. NO._ <br /> � ❑ OWNER �'AGENT DATE . _.J_/��I �j1� - <br /> APPLICANT/FIRM REPRESENTED . _ .��/Zy�_ _�•. /U�Q�N__�.I3f�//t?OR_�TI}—c.,GY.�Sf�QL(C�" �•n� <br /> / 7 <br /> ADDRESS /� ���4jLS ��• CITY �l, �'�L�/�TELEPHONE �S�— <br /> tiEREBY APPLIES FOR PERMISSION 70 _���__.������J�_bfZl�c���> <br /> r-- <br /> AT THE FOLLOWING LOCATION �LCo_31�____KL�S,(�F2T�/��� <br /> Attach five(5)copies of preliminary plans for proposed work.Draw to scale and show the following as applicable: <br /> ' Property line:. and street identity. ' Topographic changes requiring cuts and fills <br /> ` Outline and dimensions of existinfl and other than normal foundation. <br /> proposed structures. * On-site drainage systems when required. <br /> ' Existing and proposed utilities. ` Erosion control methods when required. <br /> • Centerline of abutting right oi way. ' North ar w <br /> -- ( - ��40''�/'" �� <br /> Si natureolAD0licant <br /> corvoirioNs: PUBLIC WORKS PER T <br /> % �X/S�IH� .SinC/� S[�tL B/ A'USS�"S �vnq�1-1 �/C USe��% Q'dd, tfU/.i' <br /> 9 n c..(/ ,�/( / /Y t' Ni�f a�l�ra�p .� � '�j Q7Ny`9Y <br /> / � <br /> `7�a /�/ir.Y. 6:.�r �c�c . <br /> °7' /tfoaf" -pl w.� ct'rai>.r ✓c!•-� P� �e `775 �1 �n"e�1 <br /> � 5���Sc�w P--�u <br /> + , .�_: f.._ , !_ <br /> The unacrsigned owner hereby aB�ees lo ho10 an0 sava�ermlana <br /> Ihe Cily ol Everetl hom any ana a�� c�eims for damepe0. cost0. <br /> expenses,or causes ot ection Ihaf may arise becauee of inet�lletlon <br /> �� and maintanance ol the improvement or olher riyht-oFwey uee <br /> herelo apP�ied for antl lurther aBreee fo remova aeme upon nollce <br /> � from the City anA lo replace public property EemaO� thereby. <br /> � ED FOR C NSTRUCTI A \ACKNOWLEDGEMENT OF CONDITIONS - <br /> I � / J . � G�' ��' � � <br /> �i�.� �_C��<d=.._-. 3' 7' �� // �v 5�.. <br /> APPROVED AS CONSTRUCTED DATE SI N TU APPLICANT DATE <br /> PERMIT IS VALID FOR 1 YEAR pOST ON CALL FOR IN�PECTION <br /> JOBSITE 259•8811 <br /> ( EXPIRATION 24HRS. BEFORECONSTRUCTION � <br />