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Application For
<br />� ��I ORKS PERMIT
<br />DEC 12 �995 U I WORKS�EPARTMENT
<br />3200 Cedar Street
<br />J ................................... Everett. WA 98201 259-8810
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<br />TYPE OR PRIN7 dNL�ermit Counter
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<br />Applicant
<br />Describe Proposed Work
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<br />Date_ �.% / �� /
<br />Public Works Permit R / S -�
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<br />Mailing Address
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<br />PROJECT ADDqESS (if known) � � J7
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<br />Zip
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<br />Zv�-347- 3
<br />Attach four (4) copies of plans for proposed work - Draw to scale and no�e �he followirl"g if applicahle:
<br />•Property Lines 'Outline and dimensions of all exisling and proposed s�ructures on the lot •Existing and proposed utilities
<br />•Centerline of street •Indlcate Norih •Show any proposed grading changes •Show measurements
<br />PERMIT CONDITIONS:
<br />t. All calls for inspection shall be made 24 hours in advance - phone 259-8810.
<br />2. All work shall be performed in accordance with this permit and current City of Everett Design and
<br />Construction Standards and Specifications.
<br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555.
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<br />',��RTtR 4.250.00
<br />CHECI; 4�70.00
<br />ACKNOWLE�GEMENT OF CONDITIONS
<br />The undcrsigned owner/applicant hereby agrees lo hold and save harmless
<br />ihe City of Everett trom any and ali claims for damages, costs, expenses, or
<br />causes of action Ihat may anse because of installation and maiMenance ol
<br />the improvement or other right-ohway usa her applied for ano turther agrees
<br />ro remove same upon notice from thg,Ci a d lo replace public property
<br />damaged iher� � �
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<br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITFIIN 180 DAYS OF DATE PERIv11T IS ISSUED AND TH'REAFTER IS TO BE DILIGENTLY PURSUEO TO
<br />COMPLEf10N. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.
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