Laserfiche WebLink
� M'�" APPLICATI�.N FOR PUBLIC WORh.a PERMIT <br />e TYPe Or Orinl cleatlY wit� .�� <br />PRESS HARD • YOU ARE MAKING COPIES pERMIT NO. �� Z�� <br />PUBUC WORKS <br />EV@RETT, WASHINGTON BLDG. DEPT. N�i. <br />�OWNER ❑ AGENT DATE I ' I�l' '� �-- <br />�� APPLICANT/FIRM REPRESENTED �.-�� -• ` ��'^ �� ��� <br />ADDRESS `�= ^ � `w:' �, * v CITY Y,�Ieri,�"f' TELEPHONE �� �'`7'``'�.5 <br />HEREBY APPUES FOR PERMISSION TO ���—S�,r �'�" � �^ � ' t —� '� i � r � �•- �*�� ,+" — <br />� <br />.` 1. �.(, �._l.�T �=��� �r — -- t r'�F�C. Fv L,\.�T-- D` e�. � r- t_..L `--`�� J -t+c. <br />AT THE FOLLOWING LOCATION = <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. ' T,opographic changes requiring cuts and fills <br />' Outline and dimansions of existing and other than normal foundation. <br />proposed structures. " Un-site drainage systems when required. <br />• Existing and proposed utilities. ' Erosion control methods when required. <br />• Ce�terline of abutting right o( way. ' North arrow �i <br />CONOITIONS: <br />��.. �. � . , � <br />'� �; 1���u« dt�veway� �a �S �...de „�.�.�., o�� <br />�', � . . � � <br />r. . . . . .l'2Vr-�'Ci' �rV..� � C�C�.�ewo...`G Ir pnr�c�a` �ui' .��1�.'] . . <br />...... . . 1 1 <br />,. w_,���_ Dlf �N�III, <br />;; : <br />`' ''�. "S� si a ll <br />� . <br />�� � � <br />.r�!.vP�+.A �.i.p�o.1S .PP! Jt�PWA � � I.O . . . . _ . . . <br />1 1 <br />-ryPP � - a+} a : : <br />, . 5<«<..,� s S s�,��.; � ; . <br />io 'Sol,c� �Phce -�vr ` n . I . : <br />� �. <br />. j /'� . . OF //1 NH i . . . <br />r 1 <br />. �..�. .�NS�Ir// w/lP� �7y�S OS ShUwn 0...� a�GnS <br />..�1 ��.: . . . . . p <br />J t ,..- . . . <br />. �, <br />��� __ �._ : :.. . _ . __._. _ _ . . <br />I . . . i • . . . . . . . , . . . , � . . <br />J'? :f� �,y-� � <br />%�--�` � / <br />� /�VED FC�R CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />\-�� <br />� <br />. . . . ._��� ! <br />. . . . . . Y . <br />The untlersignetl owner hereby agrees to hold anE aeve hermlesa <br />Ihe City of Everett trom eny ana au clalms br dameqes, coet0. ' <br />e�penaes, or causes ol ection Ihat may ariee bacnuee ol Inntellation '. <br />and maintenanco ol ihe improvemenl or ot�ar right•of�wey uee <br />herelo applietl �Or and fUrt�Br OgrCCe �o rOmOva 80m8 upOn nOUte , <br />Imm the Ciry an0 ta replece public property dameqe0 thereby. <br />i=/•r= � Z- <br />PERMIT IS VALID FOR 1 YEAR CALL FOR INSPECTION <br />POST ON 259-8817 <br />EXPIRATION � ��� �-3 JOBSITE 24HRS.8EFORECONSTRUCTION <br />t <br />