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e <br />9/8/95 <br />Date <br />Application For <br />PUBLIC WORKS PERMIT <br />TO POSTING z-� - <br />Print or Type Only <br />Loren Dorrah 2820 Lincoln Wy Ste B Lynnwood 98046 <br />Owner <br />Applicant <br />A�:dress <br />Mailina Address <br />Gty <br />Ciry <br />Describe Proposed Work New House= Basic 1114 <br />Project Address (it knownl <br />Pubhc Ylorks Permit � • �/�`�— <br />81Eg. DeO�� + <br />Puhlic WarFs Fee $ <br />Toiai Fee <br />Less/oO��FeePai4 S �D� - <br />Balance Due $ � <br />787-6700 <br />Attach four (4) copies of plans for proposed work � Drav: to scale ann note ine �ollowmg as apVlir.able: <br />• ProPerty Lines • Centerline pt street .__ . _,:...` . . -, .. '_.'.'�,.� .;._�, <br />• Indicate North � <br />• Outline and dimensions of all existing and � cnow any rroposed gratling changr.s <br />proposed struclures on the lot � Show measurements '3�C�'�`� ���5'�_'.. <br />• Existing and proposed utilities _ _ <br />Phone <br />Phone <br />DO NOT WRITE BELOW THIS LINE �-��;1;�!."';. , <br />PERMITCONDITIONS �"�_.`� ��'''-��'- <br />t. All calls tor inspection shall be made 24 hra. in advance - phone 259•8810. <br />2. All work shall be pedormed in acwrdance with this permit and current City of Everett Design and Const[ucti0n';! <br />Standards and Specifications. � ': <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•a24-5555. .. �,.; �. ;,.. <br />d. Provtde S oCf' etreet parking stall f'or the duplex. <br />i, koof-[ep �vnotF shall be directed to U�e in[i1ti'ation system provided on the lot. <br />����PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259•8810 . <br />W <br />H <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLEDG[MENT OF CONDITIONS <br />7he undersi4ned owner/applicant hereby agrees to hold and save harm• <br />less liie Ciry of Everett from any and all claims for damages. cosls. <br />expenses. or causes ot action that may arise because of installation <br />anA main�enance o! the improvement or other right�of-way use herelo <br />apphed lor and further agrees to remove same upon notice liom Ihe <br />Ci!e antl to replaca Pub6c properiy damaged thereby. <br />9/x�l�S <br />S- ature of APPlicant <br />Date <br />K AUTHORI2ED BY THI RMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IEGT OVER 90 DAYS DURATION. <br />