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//���� -�`? POSTING � � J �v�
<br /> `/ APPlitation Fw
<br /> F'UBLIC WORKS PERMIT oate 10-22-96 �
<br /> PUBLIC WORKS DEPARTMENT Public Worus Pertnk 8 ___���q�{•I / _ .
<br /> 3200 Cedar Street �T��
<br /> Everett,WA 98201 259-8810 . �� � ��
<br /> euilding Permk M 53305
<br /> NPE OR PRINT ONLY - ' ,
<br /> Public Works Fee$ � �
<br /> Loren Dorrah 2820 B Lincoln Way Lynnwood 98036 787-6700
<br /> , Owner Mailing qddress --
<br /> City Zip Phone
<br /> Owner
<br /> Applicant Idailing Address
<br /> City ZiP Phore � � .-��>�
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<br /> Describe Proposed Work neW �� Q,�p�p,x r .
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<br /> PROJECT ADDRESS(if known) 10425 19th Ave SE Lot 4 BSP �1d-96 ' '
<br /> � . �.
<br /> . � Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: m ��
<br /> � •Property Lines 'Outline and dimensions of all existing and proposed sWctures on the lot •Existing and proposed utilities ��T
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<br /> � •Centedina of street •Indicate North •Show an . � �^'�
<br /> y proposed grading changes Show measurements . �•
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<br /> DO NOT WRITE BELOW THIS LINE `''�` ;`
<br /> PERPAIT CONDITIONS: � '�,�'
<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 with this permit and current City of Everett Design and O , ;�c
<br /> Construction Standards and Specifications.
<br /> 3. Call Location Underground Service 46 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555, l�,J�
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<br /> li/OB/96 10:54AM �ORNBS O:E: � ��'1�
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<br /> qOD053457 a '�T:
<br /> ELEC 411�.00
<br /> R00053i05 `,.,i''`'
<br /> ELDG 31c^S5.Q0 �,``'�>�.,�,
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<br /> �'LEG 415k.00 ;,;;,;;r •
<br /> MECH 31�O.OQ �•�,n,,� .
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<br /> SRCHRG 44.50 '.'hy.E.
<br /> DF.IVW'/ 420.00 .t;r.`c`�:,
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<br /> H00009185 �',t,;:•i,`: '
<br /> WRTEF 8130.Od ;:�R-`f �h�
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<br /> #OOU30879 (�p.,f•.i� ,
<br /> SEWER 370.00 `'',� `
<br /> v S�'SDEV 41884,OD
<br /> ACKNOWLE�$3�f OF�p�pNS
<br /> �,,q Ob
<br /> /r/(�'li+_ _ /Q 2/ /�l The undersigned owneNapplic���nehy a9��o geld and save harmless
<br /> // ( `�.Q.Q.i �J / (p the City of Everett from any and all claims tor damages,costs,expenses,or
<br /> Ap roved for Construction Date ��—� causes of action that may arise because ot inslallation and maintenance of
<br /> �(���n / theimprovementorotherright-of-wayuseheretoappliedforandfurtheragrees
<br /> (�i, / to remove same upon notice from the City and to replace public property
<br /> 7�i�—� ¢C�i� damaged thzreby.
<br /> FINAL INSPECTION Date �����%"Y"� .
<br /> Approved as Constructed
<br /> ll-i�-�j'/��
<br /> � Signatur of Applicant Date
<br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WRHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFfER i5 TO BE DILIGENTLY pURSUED TO
<br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED 6Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.
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