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� <br />� <br />TYPE OR PRINT ONLY <br />Loren Dorrah <br />Applica�ion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259•BB70 <br />'�: �O�TlyG <br />2820B Lincoln <br />M�iling Address <br />Date 5-20-96 <br />Public Works Permil N �� Z� S <br />( � euildinc� Permit s 51776 <br />I�"S_c. zv_ <br />Public Works Fee $ <br />�d 98036 787-6700 <br />cip <br />Curt Johnson 337-4733 <br />Applicant Mailing qddress City Zip Phorn: <br />Describe Proposed Work Ilew duplex <br />PROJECT ADDRESS (if known) <br />216 Dorn Ave <br />Lot 4 SP 27-95 <br />Attach foi�r (4) copies of plans tor proposed work - Draw to scale and note the following if applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />'Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />�.v �vvi YY1111C DCLVVV irnJ urvt Q°i,'30/96 11:53RM OOOpIf601 <br />PERMIT CONDITIONS: � <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810, qpppg1776 <br />2. All work shall be performed in accordance with this permit and current City of �i@�tt Dg�i�7y�{1 <br />Construction Standards and Specifications. FL�'i 9154. ;10 <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMj�1-80q}g;;pg55, <br />Sf`iCHRG 56.50 <br />DRIVWV 520.00 <br />��. Recp cify stree�c cfea�t at all times. HD0008934 m <br />S. CIU� �;l1UCC 811(I SIdCWBIIC Iil UIC �ll8l :0'C Ill'W :10� Ilfll��fl18�'C(�. 3f1}' 1IU1118�,C �a���C�ICNIJI'ClI 8I III� <br />discretion ofthe Fublic Works Inspecror. <br />b• rVrv chanee ui Ilie driveway cut miut be approved by Nic 1'W Ins�ector. ��` _?�'� <br />'. Adjust watcr boxcs to grade at cnd of constnutimi, SYSDEV 51664.00 <br />4. Dm�eways shui! be completel}� cured before dm�ng on them. �DIII 57.:5.00 <br />9. Side scwer mu( Sto�m sewer comiec6ons shall be installed as per thc appro ed ctonsfn G un p� i'or diz <br />;hoit plat uuprovemenls. <br />W <br />F- <br />- <br />� <br />� <br />O <br />� <br />k:k:t'K <br />� <br />O <br />/�/� <br />V♦ <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDI.TIONS <br />lhe undersigned owner/applicant hereby acrees to hold and save harmless <br />the City of Everett from any and all cla:ms for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance oi <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice Irom the City and to replace public property <br />damaged thereby. <br />I nrvn� nvare� i iun- v DSte ' I <br />Approved as Constructed <br />' �� �) ��%i <br />Sign ture Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT I ISSUED ANO THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COAIPLETION. THIS PERMIT MAY BE CANCELLED BY TF![ CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />