Laserfiche WebLink
1 <br />ro <br />APPLICATION FOR PUBLIC WC ,-AS PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. <br />PUBLIC WORKS <br />EVERETT, W�NGTON <br />❑ OWNER AGENT DATE C{$Z BLDG. DEPT. NO. _ <br />APPLICANT/FIRM REPRESENTED <br />ADDRESS CITY�TELEPHONE <br />Va.Tr>t%• <br />HERE2y,9PIP� S FOI,PERMISSl9f�-T9 bi,(7fV--_ <br />41 A l it, — <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 />PUBLIC WORKS PER <br />f <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and ab claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />i from the City and to replace public property damaged thereby. <br />*PFROVED FOR CON RUCTIO DATE ACKNOWLEDGEMENT OF CONDITIONS -f <br />APPROVED AS CONSTRUCTED DATE SlaNATURE OF APPLICANT DATE <br />PERMIT IS VALID FOR 1 YEAR POST CALL FOR INSPECTION <br />POON <br />POST 259-8811 <br />EXPIRATION 24 HRS. BEFORE CONSTRUCTION <br />