Laserfiche WebLink
'__ <br />� <br />� <br />everett qppLlCATIOI� �OR PUBLI� VIlORKS PERPJIIT <br />� TYPe or Print clearlY with ink <br />PRESS HARD - YOU ARE MAKING COPIES �3/Z. Z <br />PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON /_ BLDG. DEPT. NO. b-'���!� �-� <br />� '�, : <br />�OWNER ❑ AGENT DATE � .� ��� � <br />l '/ - <br />APPUCANT/FIRM REPRESENTED . J�« � � �r���-�' --��✓�- <br />ADDRESS y� �� � � e . ��L=��I ��/f LL (.(�/f��CITY C� ��� T[LEPHONE ."> >'� - ����" <br />hIEREBY APPLIES FOR PERMISSICN TO _�"�"�cC �'S � l•'�/t�•" ��� �'�t=%F r���' :'�=�"if y <br />- — — , <br />ATTHE FOLLOWING LOCATION C�=_�` �. v��tL'%Vf:- L���� ��._��_�_ 7a I O ��� ��'• W� <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 />/. <br />2, <br />3. <br />' Topographic c�ianges requiring cuts and fills <br />other than normal foundation. <br />* On-site drainage systems when required. <br />' Erosion control methods when required. <br />`iroorf rrow �� � <br />� � �- <br />( ,�,�� � � <br />\ ; ai %�t � , ` ��=- <br />PUBLIC WORKS PERMIT <br />, <br />�r�r.. -/.3��i f F(1SP IH Fk i�•rr�_ is �� f� b P ��rG�.�, i� <br />/(Oo�7� ll'/CT/nvTf /»vJi be con7�'/n��r�/, Gn l�ii� �7`-; <br />� <br />�C7/L/.Sf" !�✓��'9�i SP/✓i[�e !JN/Vf k�k '� irlK/ // �'i"�!/P, <br />J <br />PERIV4ll' IS VALID <br />EXPIRATIOFv <br />1 <br />�( i <br />'_ . r _. f ._.� j I 1_.. <br />, ._ ! ._._� � I <br />lf � � <br />"�.,.._� . . . 1 1 .1 . . i , i . <br />, ; .: . .� '.. <br />.__ ._� __. _.. .-, ,_.. i � . .,._ <br />. ....{�-� �r; . . , . . <br />The untlersigned owner hereby agrees to hold antl save harmleos <br />the Cily ol Everelt tror� any ano an ciaims for damagoe, cosis, <br />expenses, or causes ol aclion �hal may arise Uecause ol ins:allation <br />and maintenance ol !ne impmvement or olher righ4obway use <br />herelo applied for and lurther aBrees to remove same upon notice <br />from the City sntl to ;aplace public property demagetl Ihereby. <br />OF <br />POST LN CALL F�R INSPECTIQhs <br />JOBSITE 25, b811 <br />2� HRS. BEFOfiE CONSTRUCTION <br />� <br />� <br />