Laserfiche WebLink
ew APPLICATIr ,N FOR PUBLIC WORKS PERMIT <br /> c Type or print clearly with ink <br /> AKp 3 <br /> PRESS HARD-YOU ARE MING COPIES () <br /> PERMIT NO. <br /> PUBLIC WORKS <br /> EVERETT, WASHINGTON BLDG. DEPT. NO. <br /> 174 OWNER ❑ AGENT DATE L <br /> APPLICANT/FIRM. REPRESENTED r r~ •�c� _j F r -e-- <br /> ADDRESS _1131C <br /> ADDRESS _11311, CITY f tl TELEPHONE 353 y� <br /> HEREBY APPLIES FOR PERMISSION TO <br /> -T—Sti a <br /> AT THE FOLLOWING LOCATION <br /> Attach five(5)copies of prelim'nary plans for proposed work Draw to scale and show the following as applicable: <br /> • Property lines and street identity. a Topographic changes 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 o' abutting right of way. • North arrow <br /> 44n. re of Applica d <br /> PUBLIC WORKS PERD41T <br /> CONDITIONS: , <br /> .-. . . . . . . . <br /> i . . . . . . . . . . . . . <br /> . . . . . . . . . <br /> . ... . . .. . . . . . . . . . . . . . . <br /> Thu undersigned owner hereby agrees to hold and save harmless <br /> I the City M Everett born any and all claims for damages, coats, <br /> . . . . . . . i - expenses,or causes of action that may arise because of installation <br /> ._. . . . . i and maintenance of the improvement or other right-obway 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 /> 1AE <br /> O�NST U� EACKNOWLEDGEMENT OF CONDITIONS <br /> 2, /�DA CON RU D ATE 5 ATURE OF LI ANC T DATE <br /> PERMIT IS VALI OR 1 YEAR POST ON CALL FOR INSPECTION <br /> 259-8811 <br /> EXPIRATION _ JOBSITE 24HRS. BEFORE CONSTRUCTION <br />