Laserfiche WebLink
APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or pn 1 [ learty with Ink <br />PRESS HARD • YO'J ARE MAKING COPIES PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON 1 I <br />❑OWNER *AGENT DATE _.��Jjf BLDG. <br />APPLICANT/FIRM REPRESENTED -_ _�—.KVU <br />AD(TRESS Z "'0 CITY &2YKI.AI/)_TELEPHONE (4Q <br />HEREBY APPLIES FOR PERMISSION TOC,40 <br />AT THE FOLLOWING LOCATION —15t-0 f7 h1 if <br />Attach five (5) copies of preliminary plans for proposed work Draw to scale and show the following as applicable: <br />I <br />• Property lines and street identity. • Topographic changes requiring cuts and fills <br />Outline and dimensions of existing and other than normal foundation. <br />proposed structures. On-sil 1 drainage systems when required. <br />• Existing and proposed utilities. • Erosic n control methods wh n required. <br />. Centerline of abutting right of way. • No h rrow <br />SLY <br />Si ature of Ap icant <br />PUBLIC WORKS PEERMIT <br />CONDITIONS: <br />Qeer, cuH 1.3 of Ilo�rr� ills w <br />Cx cau'4. 1.,., cFi" r iy <br />\11,.r11 be rzlluwPJQ I ex <br />Act 1Y cross 1 <br />f:ll o{I.er � Grosarw �) 6—� %v Iut <br />oq j. Ib+L kvc w ideiwtr, <br />-4v 4e <br />T t J.. e r e j b tp .. <br />bo f lk 0, <br />l5 'q a,..S' 9 oa roue... <br />S c\lt1\Gci tor\ o< -F(.e <br />3. CoA� (,•., of <br />Ile,., <br />S w <br />aJ <br />QJ 11 <br />I 1-...../� <br />I�ss.Sn,t.Lcdcirres - 151d� 8 - I"1z0 <br />9 - IbLO <br />. to - ISso <br />7-� '" y- / p I L - 13 iD <br />i� �0 O '- 1 T l O <br />PROVE��FORQC/ONS CTION qTE --- A <br />I <br />NPP TRtf — ---- - DATE <br />S <br />PERMIT IS VALID FOR 1 YEAR <br />.—...•. w.+.. � . . <br />I <br />o L 61v c!, a.,..S< <br />P— 611 <br />L.J or K% TH yry <br />Sl.wll ire. P is - PIA.s S <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costa, <br />expenses, or causes of action that may edge because of Installation <br />and maintenance of the Improvement or other dghtol•way 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 />OF <br />2 <br />POST ON CALL FOR INSPECTION <br />JORSITE n a une noc88na1 <br />crolgnrgn�t <br />1 <br />I <br />11 <br />ill <br />