Laserfiche WebLink
evere APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. �y <br />PUBLIC WORKS <br />EVERETT, WASHINGTON �` BLDG. DEPT. NO. <br />❑ OWNER ❑ AGENT DATE .3 <br />APPLICANT/FIRM REPRESENTED LU���IH� maibl ` - -- <br />ADDRESS 3 ,� .0 (Ie�/// c'/1� iJ%/�� CITY `' TELEPHONE <br />HEREBY APPLIES FOR PERMISSION TO/ '� l �( '/ F N�'F f R' _ LG ' <br />J(/r7 U 4s— <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. <br />• Outline and dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />CONDITIONS: <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 <br />Signature of APPbcanl <br />PUBLIC WORKS PERMIT <br />�A"1 ()I,c a.�. -y-•' fCCo�vy; icT.OVT W.;..1 >°•� w.a ,.:� <br />a�L <br />'�IU �AtN G�CGe59 -�ro Sa'�r� <br />�rcAe�.'VwazKS WIC ap(oGca.A— <br />f�sGjo..9. b,'I t:�N <-iv rl'w�o ve se .w re, coxc=44' I The undersigned owner hereby agrees to hold and save harmless <br />�E �rJ7��G jr the City of Everett from any and an claims for damages, costs. <br />expenses, or causes of action that may arise because of Installation <br />and mnintenance of the Improvement or ether right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />p from the City and to replace public property damaged thereby. <br />P OE FO N RUCTION AT ACKNOWLEDGEMENT CF CONDITIONS <br />1 39 <br />APPROVED AS CONST UCT. D DATE SIGNATURE OF�� PP �AFTT DATE <br />PERIViIT IS ILAV D F )R 1 YEAR CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />EXPIRATION ------ — — <br />fl <br />