Laserfiche WebLink
everert APPLICATION FOR PUBLIC WORKS PERMIT <br />Type Of print dear.y wnh ink <br />PRESS HARD • YOU ARE MAKING COPIFS <br />PUBLIC WORKS PERMIT NO. pp,, //,7 <br />�s <br />EVERETT, WASHINGTON .Z.3 <br />KOWNER O AGENT DATE S-- e, 42 BLDG. DEPT. NO/�l <br />APPLICANT/FIRM REPRESENTED% /-1-I!S_L"t-5_li Ie� <br />ADDRESS Ire" Sr F✓E%1F/T /))f{ (_ (ifI `/ CITY 71 TELEPHONE .3SS'U�y <br />HEREBY APPLIES FOR PERMISSION TO f'V 5 (A(� W+�E 4&Vrt2C ?F L—LR/vFwif / <br />ATTHE FOLLOWING LOCATION /Or fI/i 4-PAI450-4E ES7if1_6.'5 _0 <br />Attach live (6) copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br />• Property lines and street identity. <br />• Outline End dimensions of existing and <br />proposed structures. <br />• Existing and proposed utilities. <br />• Centerline of abutting right of way. <br />• Topographic changes requiring cuts and fills <br />other than normal foundation. <br />• On -site drainage systems when required. <br />• Erosion control ethods when required. <br />*70rt <br />arr,w <br />— V `, _ � <br />SI afore of Applicant <br />PUBLIC WORKS PERMI <br />CONDITIONS: 1 <br />/�t7J7 �fJ �A(.+Oje Her✓3� Ue 'A'" /o//,n�(�j a., W" /o'e, <br />C2, j�+, Nr CTPrrr lJ'JC r" <br />. .Q Pc`l.(y'Irtrr CyyC,,�� (�uF '�p- Co H/S i//N i e. I L) -v <br />f er/Jaire 6 r yrf/ <br />7v <br />FtNAt. Z►�s/ae�ie�1�% <br />Ritz . OC.C.uPpiED , ForC some- -rIHE <br />DFILNIQ .ate ROOS OUSP-LAM <br />$10RM DRAilO SYS. ON LOT <br />APPROVE FO--R-?,;ONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION S- 7-1 <br />A, bLft A? U. cti, <br />or" N .S t- r/r0 Q. <br />,P. o. <br />t:> lU /4 r,ew AQA)I1J5PECr=(( <br />the nndersigned owner here y %WWharmless <br />/ 12._3 the City of Everett from any and all claims for damages, costs, <br />expenses. or causes of action that may arise because of Installsllon <br />and nialolenance of Ile Improverriertt or other right-ol•Way use <br />herelo applied for and further agrees to remove same upon notice <br />1 from the City and to replace public property damaged Ih♦!eby. <br />Cbt F%�,-SCM WLEDGEMENrQFCONDITIO( S <br />URE. OF APPLICANT DATE <br />POST N CALL FOR INSPECTION <br />259-8811 <br />JOSSITE <br />24 HRS. BEFORE CONSTRUCTION <br />�3 <br />