Laserfiche WebLink
,. <br /> -- — '1 <br /> -- — —- -- -- — -- -- - <br /> ,-- , <br /> "'�'�" APPLIGATION FOR PUBLIC WORKS PERMIT <br /> � Typa w D�nt de�rly wlth Ink <br /> PRESS FIARD•YOU AHE MAK�NG COPIES p�RM1T NO.�3 S 3 <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON G BLDG.DEPT. NO. <br /> , ❑ OWNER �AGENT DATE � aS O 3 <br /> APPLICANT/FIRM REPRESENTED ^ `L�Ti � <br /> ADDFESS �n �.�������� F3-CITY�TELEPHONE�3��I-'�01� <br /> HEREBY APPLIES FOii PERMISSION �� �o�v-a�^�u� 0. Z ` , <br /> � t .i� �t-�a 4,.�C�sL <br /> Z� <br /> ATTHE FOLLOWING LOCATION tI2--��N`��'�A �� • �A*R�-�� �1-�R • <br /> Attach five(5)copies of preliminary plans for proposed work Draw to scale and show the followfng as applicable: <br /> ' Property lines and street identity. 'Topographic changes requiring cuta and fills <br /> 'Uutline and dimensions of existing and other thar normal foundetion. <br /> proposed structures. ' On-sit3 drainege systems when required. <br /> • ExisHng and proposed utiflties. • Erosi��n control methods when required. <br /> • Centerline of abutting right of way. • North arrow <br /> ��' rrt.�rv�,���.�g,�w(��� <br /> "��iureot�ovuc�nt �p� <br /> PUBLIC WORKS P RMIT <br /> CONDITIONS; - - � ; . <br /> � : l. SeveN� �� /�cllJive :sl,�i� b< �cP � clro� �.�9n <br /> . . : � . . . . . . . . �ii�". a�..S/ .de bf�f . 1� v�ot' � be "tT��y O� O� <br /> �1..._.._ . . . . . �..A��. .�'� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ _ . <br /> � , . . . . . . . . . . . . . . . . . . <br /> ' . . f . , . . . . : _ . ; , . . . 1 •� . . <br /> � . .- : . . . . � . � � , . . . � . . , {� • . � , _ .`. . _ .' _' _. i -. _ . �_� . i . . <br /> . . � i <br /> I , , �I� 1_ j . ' t � . . . . <br /> ..�. • . : � —,__�_��- . . .T i . . . ._ . ' _... ..�_-.-.-1 • ' _ ' ._....-t�, 1. ._...-.--}--�.-' ' . . . <br /> _ ,' , ���4 � . . ) . . � .. . . � . � . . . . � . � � . . ' . . , . . i . . . . . . .. . <br /> . � . .. �_� . I . . . . ._—{-�� .$--_. . y_ - . � . . _ . . . . I . . . . . . � � . . . . . . . . , <br /> I : : . : : � . '. i . :�� . ; j . . . ; . : � ; <br /> . , . <br /> ��' � ��-� -������- � � � � The undersignetl owner here0y aqrees to hold and ewe harmless <br /> I � . . �. � .� .. � . . , , . , : � . . , . . ihe Gry of Everett tmm eny ena all cielms lor A�m�pe�, costti <br /> 4 , ; eapenaes,or caueee ot ection I��t may ariee bsc�une d ImtdlUlon <br /> � _,.__. . . _... . . . . . . . . . . .. . _ . . . - . � and msintenance ol the Improvement or ot�ar tlOh4o1•wsy use <br /> f . . . � . . . . . . . . . . . . hmeto applieE tor entl furihar e9reea to�emove wms upon notice <br /> , . . . . . . . . . � . � � � Irom Ihe Cily antl to �av�ace public Droperty O�meped t�eroby. <br /> ,/� ' � . . . . . . ��.-� <br /> � PROVED F CONSTRUCTIO DFlTE ACKNOWLEDGEMENT OF CONDITIONS <br /> • �.�C�---///-!f� � � '' �A, \a.v�+� <br /> R D AS CONSTRUCTED T SIONATU OF AP LI ANT DATE �� <br /> PERMIT IS VALID FO EAR ppST ON CALL FOR INSPECTION <br /> - - � JOBSITE 259-8811 <br /> � EXPIRATION 24HRS. BEFORECONSTRUCTION <br /> � <br />