Laserfiche WebLink
everett APPLICATiON FOR PUBLIC WORKS PERMIT <br />� TYPa or pnnl Ueetly wilh mk <br />PRESS HARD • YOU ARE MAKING COPIES g�/a�,� <br />PUBLIC WORKS PEHMIT NO. <br />EVERETT, WAoHINGTON � �/ O � � � <br />., � BLDG. DEPT. NO. .8�� � %�� <br />i'�OWNER f7AGEN? DATE 1 `�' � i�'; <br />APPLICANT/FIRM REPFESENTED ��/�-� !S _�'.,L�-�ILE-.-� - ���"�-�'" <br />/ _ <br />ADDfiESS _Zf: 'Y' ' '� C . C r � /��� _'/_ �I ��=L- (�`�� % CITY i �G �- �� �.~'I . TELEPHONE � _�S� !�C/�! �- <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />�� '._'fi i. —.'. � � .! ��_'. __/_�,..,. . i ;i . _ . �i , ' lO/{�� <br />:�'1 l��ii� �.� c ���i,�i,� •_-�8 7y�st. s.��, <br />Attach five (5) copies of Nreliminary plans for proposed work. Draw to scale and show the following as applicable: <br />• Property lires and street identity. • Topogrnph;c changes requiring cuts and fills <br />• Outline and dimensions of existing and other tfian normal foundation. <br />proposed stnictures. • On-site drainage systems when required. <br />• Existing and proposed utililies. • Erosion control methods when required. <br />' Centerline of abutting right oi way. • Nor1q arrqw ; � � <br />,� � <br />1 � -'' i ' <br />� L. _ ; � �,, <br />'— ` F `�SlBnalu�olAPPiiqn('- <br />coNoiTioNs: PUBLIC WORKS PERMIT <br />u �. <br />1. re�.� - 6�?+ ca�r v��...-1 �re�. �-s <br />oZ. F1a� �1a..,.aye .,� ,ort.��ca �� � <br />�N G. -� toN 3-�r... ct�u.'� �xND�' 10 t <br />,3. �rb�1, -4TM1�1�.�.9 ;,.�. "n�Nbl;� R,o <br />sr�{., �s .`-o �,c c�e...nr✓ v,r cia.�� <br />no} -1� �e c�tc�rri�! <br />P���1�� R.O� 1.�1. 4ccwr�.qC <br />repa,�.S2 b,� 6H,I�c� � <br />,/:%• '�WM' -�\< C.QN1�iYtGrlO�n <br />� � 1 T'��rnl, rou� �rn�n5 'io C.l'J �.. �'itfe..� ntw�r 1J.W. n <br />Gorn[r u-F �lep[�/. -T-�na`�tll �n (e'i� � qr-vD�.r� ��'r�P- ta.�.1� <br />� 1 � I 1 1 1 1 <br />3�w.��e �r* vGw.a� 'k"" a�Vt�- w�+,4w� -�,o i.. e-{� <br />PERMIT IS <br />EXPIRATION <br />�_— �/.�r f2 <br />:TICN % DAT <br />--�%!�;-� 5 --- <br />E DATE <br />FOR 1 YEAR —I <br />I hc onaersigneA owner hereby xBrees �o �old antl eeve humlese <br />�.he Qty ol Evainu �mm eny ena eu cieime br tlemepe0. coel�, <br />e�pensea or caueae ol action Ihet mey erine beceuea ol Ineldlslbn <br />nnA mainlxnence ol t�e Improvemenl or ot�er tlp�l-ol�wry u�e <br />herelo epplied lor antl lurlher agreee lo remova eame upon notlte <br />Irnm Ihe Ctly antl 1a mplece publlc property demeped I�ereby. <br />�-��-� z <br />DATE <br />/ CALL FOR INSPECTION <br />P05T ON 259•8811 <br />J08SITE 24 HRS. BEFORECONSTRUCTION <br />