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ADP�����on For <br />r�� �9,�Tl��i ��-5-�i� <br />� PUBLIC WORKS PERMIT Date 5-20-96 %� <br />PUBLIC WORKS DEPARTMENT Public Works Permit p `"l �Y/ Z�/�O <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 Building Permit k 51777 <br />TYPE OR PRINT ONLY <br />Public Works Fee $ �.0 <br />Loren Dorrah 2820B Lincoln Way Lynnwood 98036 787-6700 <br />Owner Mailing Address City Zip Phone <br />Curt Jahnson 337-4733 <br />Applicant Mailing Address City <br />Describe Proposed Work new <br />PROJECT ADDRESS (if known) <br />Dorn Ave <br />� SP 27-95��9b 11�58{�M 000{ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: �1�t1 <br />•PropeAy Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and p d utilitre5120.50 <br />•Centerline of street •Indicate North •Show any proposed grading changes •Show measurements � si�'� <br />IKf'Y ti'N1. M <br />PERMIT CONDITIONS: �� s�•� <br />1. All cails for inspection shall be made 24 hours in advance - phone 259-8810. H000089:{5 <br />2. All work shall be performed in accordance with this permit and current City of BIl�tt Dest�tSOrAU <br />Construction Standards and Specifications. N00030633 <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM�f`i-800-4Q1U5�55. <br />SISDEV i1864.00 <br />BNDIII t725.00 � <br />d. Keep city strcets clean �t ail timr;. �� 54850.00 <br />5. Curb �uticr :wJ sidew:llli 10 lI1C NIJ� .ue new aui4 uud;w�agzd, :Illy (I�III'J�c: (I10f2I0 SI18II �d fCNlaced at W� <br />discret�on of Ihe FubGe Works Lupector. <br />6. A�ry cliange in the driveway cut must be approvad by the PW lnspector. <br />. Adjust walcr boxcs to gtadc at ct�d of consWclion. <br />3. Dm�eways sliall be completch' cured beforc driving on them. <br />9. Side sewer :u�d Stonn sewer connections shall be installed as per ihe approvcd constniction plan For tlu <br />;hort plat improvemcnls. <br />� <br />O <br />�/� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the �ity o1 Everett trom any and all claims for damages, costs, expenses, or <br />causes of aclion that may arise because of installation and maintenance of <br />the improveinent or other right-of-way use hereto applied for and further agiees <br />to remove same upon notice from the City and to rep�ace public propeAy <br />damaged thereby. <br />Mu� .30 !'1�1b <br />Signatur f Applicant Date <br />WORK AUTHORIZED BY THIS PERMII' MUSI- BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCL'LLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DUHATION. <br />