Laserfiche WebLink
ro- <br />-11 <br />r <br />IR <br />everett APPLICA'..ON FOR PUBLIC WOhKS PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES PERMIT NO. <br />PUBLIC WORKS <br />EVERET-, WASHINGTON BLDG. DEPT. NO. <br />❑ OWNER 0 AGENT DATE <br />APPLICANT/FIRM REPRESENTED ..:_r-r_=' U ��-1 / IT '^'✓ h`-1.�1_.__ <br />ADDRESS __ .._—__- _ CITY'!' i TELEPHONE <br />HEREBY APPLIES FOR PERMISSION TO ... r f�-rl r= <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. Topographic ctianges requiring cuts and fills <br />` Outline and dimensions of existing 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 of way. North arrow <br />j <br />~ Signature of AppliCen�' <br />PUBLIC WORKS PERMIT( <br />CONDITIONS: Y _ <br />P l <br />j r <br />r> <br />1 <br />-71 <br />I J. <br />The undersigned owner hereby agrees to held and save harmless <br />the City of Everett from any and all Uamis 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 />from the City and to replace public property damaged thereby. <br />APPROVED FOR CONSTRUCTION DATE ACKNOWLEDGEMENT QF CONDITIONS <br />APPROVED AS CONSTRUCTED DATE SIGNA `- TORE OF APPLICAW DATE <br />PERMIT IS VALID FOR 1 YEAR POST ON CALL FOR INSPECTION <br />259-8811 <br />I <br />EXPIRATION JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />Ill <br />I <br />L <br />J <br />