Laserfiche WebLink
-verett APPLICATION FOR PUBLIC WORKS PERMIT <br />� i iync nr pnnl deatly wdn i.ik ' ' <br />PRESS HARD � YOU ARE MAKING COPIES i� '�'�, % <br />PU9LIC WORKS PERMIT NO. <br />�---�-- <br />EVERET", WAEHINGTON �i BLDG. DEPT. NO. ��� �� � <br />f9 OWNER Ll AGENT DATE , �' - <br />� <br />APPUCANT/FIRM REPRESENTED _ ..�:��i-<.Sit - - . ; _ . <br />ADDRESS :. _ . . _ ' . �_ ._ . _ r' _ CITY � � � . <br />HLFEBY AFPUES FOR PERMI5310N TG _ � __ , . . � _ . � i <br />.-d`-C�.,����-' �� <br />AT TH[ FOLLOWING LOCATION ��� Q • <br />� �i r' o j <br />TELEPHONE _ �"`� �" � <br />Attach five (5) copies o( preliminary plans for propused work Drew to scale and show the following as applicable� <br />• Property lines and street identity. <br />' Outline and dimensions of existiny and <br />propcsed siru�lur;:s. <br />' Existiny �nd proposed utilities. <br />' Centerline of abuttinq nyhl of way. <br />CONDITIONS: <br />• Topoyraphic chanc�es requiring cuts and fills <br />other ihan normal foundation. <br />' On•site �irainage systems when required. <br />• Erosion �;nrtrol methods when required. <br />� North arrow <br />l <br />,_ �_ � '/� . ! , .. <br />Sq)naline nl APPhCent <br />PIiBLIC WORKS PERt1AIT <br />/. / <br />(s,, � ' � ' d" _.`11�Z 3_, '� � <br />, <br />C < < _ .k. _ <br />APPROVE FQ��OON�TR�-CTIUN � OATE <br />� ��i�� ---- 11 - � `1 � 5 1 <br />APPROVED AS C01��3T CTED DATE <br />PERNlIT IS VALID FOR 1 YEAR <br />EXPIRATION <br />inr unAersigne� ownar hereby eprees to hald entl sxvo �n�n�lnss <br />mr CAy ol Evotell �mm any nna en cleims lor demepa6. coslc. <br />���ponecs. o� causee ol aclinn thet may erlee �ecauee ol inelallebon <br />:n�d mamtenence ol Ihe impiovemonl or o�har riphPO4wey un+ <br />iu•rrtlo nppheA Im T�J IUf�1101 8Q18@S �O fBTOVB lBTB I1p011 OOlib! <br />horn Ihe CiIY xnd lo replece publlc p•ope�tY dameged Inernby <br />ACKNOWLEDGE�7ENT OF CONDITIONS <br />SIGNATUREOFAPPLIGANT DF.T[ <br />POST ON I GALL FOR INSPECTION <br />259•8811 <br />JOBSITE 24 HRS. BEFORE CONSTRUCTION <br />