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� <br />� <br />TYPE OR PRINT ONLY <br />Application For <br />PUBL!C WORK� PERMIT <br />Loren Dorrah <br />PUBLIC WORKS DEPAFTMENT <br />3200 Cedar Street <br />Everett, WA 98'L01 259-8810 <br />�� � pSTING �,�-�-'� <br />2820B Lincoln Way <br />98036 <br />oate _ 5-20-96 <br />Pub"-� \Vorks Permit A ✓ f � /�� <br />Building Permit N 5177 <br />Public Works Fee $ 2� <br />787-6700 <br />Gp ruvne <br />% <br />Curt Johnson 337-4733 <br />Applicant Mailing Address City Zip Phone � <br />Describe Proposed Work new duplex <br />PROJECT ADDRESS (if known) <br />717 Tlorn Ave <br />Lot 3 SP 27-95 <br />Attach four (4) copies of plans for proposed work - Draw lo scale and note 11ie tollowing if applicable: <br />•Property Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilitles <br />•Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: pp�17'75 <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. �� ��� <br />2. All work shall be performed in accordance witl� this permit and current City of tt D <br />Construction Standards and Specifications. �� 4i1�p� <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM �-� <br />oannr� sro.ao <br />a0000e9� <br />I. Keep ciR� street�• clean al all times. WpTETi 5750.00 <br />$. CIIIII �'UIICI 801I SIIICW;tIIC III lI1C �lIBL :11C IICW �IIII UIIlI81llJged, any d;unage II�EI LC ICNIBI'tlI :{I Ili <br />discrefion oPlhe PnbGe Worlcs Lispecroc SEb1ER 570.00 <br />r,. Arrv change in ihe dnvewav cut must be apProred by Ihe YW fuspector. �`��V t18B4.00 <br />. AJjust watcr boxcs to gradc at cnd ot�conshuction. ENDIII t7^c5.00 <br />8. Pm�ew;Ns shall bc completch� cured before dii�ine on itiem. CHECY, f4850.00 <br />9. Side sewer a�id Stonn scwer connections sh,�l bc inst�lled ,is p�r the ,ipprovcd consducrion pl•�ui i'or ihe <br />sheil plal improccmcnts. <br />W <br />� <br />� <br />V♦ <br />� <br />O <br />��:K <br />� <br />C) <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner.�applicant hereby agrees to hold and save harmless <br />the Ciry of Everett trom any and ull claims for damages, costs, expenses, or <br />causes ot action that may arise because of installation and maintenance ol <br />the Improvement or other righl-of-way use hereto app�ied for and further agrees <br />to remove same upon notice irom ihe City and to replace public propeAy <br />damaged thereby. <br />hwq�� d � � <br />Signature Applicant Date <br />OMPLETION.RTHES PERMIT MA\RBE CANCELLEDTBYT E CINIUPON ANY S�TOPPAGE OF WORK OSN THIS PROJEC OVER 90 DAYS DULRATION.Y PURSUED TO <br />