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� - - _-,---, <br /> I <br /> . . �;P� �OSTING '� � I 'a�' <br /> Application For <br /> PUBLIC WORKS PERMIT Date 10-22-96 <br /> `,. PUBLIC WORKS DEPARTMENT Public Works Permit q ���T� <br /> 3200 Cedar Street <br /> Everett,WA 98201 259•8810 Building Permit# 53304 - <br /> IYPE OR PRINT ONLY Pubiic Works Fee$ ��� <br /> Loren Dorrah 2820 B Lincoln Way Lynnwood 98036 787-6700 <br /> Owner Malling Address City Zip Phone i <br /> Owner <br /> Applicant Mailing Address City Zip Phone i <br /> i <br /> Describe Proposed Work_ new l�ease- � � � <br /> � <br /> Ad-� � <br /> — 3 <br /> PROJECTADDRESS(ifknown) 10427 19th Ave SE Lot 386P 111-9b � <br /> � Attacli four(4)coples ot plans for proposed work-Drew to scale and note the following if applicable: O <br /> � •Property LJnes 'Outline and dimens!ons ot all existing and proposed structures on the lot •Existing and proposed utilities <br /> •Centerline of street •Indicate North •Show any Fry�osed grading changes •Show measurements � <br /> DO R�OT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIGNS: <br /> 1. All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground�ervice 48 hrs. before you dig. TOLL FREE NUMBER 1-800-A24-5555. � <br /> 11/OB/96 1D�SORN OC10RH859 K <br /> / ON00053458 <br /> ELEC 5110.04 � <br /> H00053304 <br /> QLDG �:�55.00 <br /> PLBG 5154,� <br /> MECH 3120.00 <br /> SF.CHR6 'b�t.50 <br /> DR IVW'I 520.00 <br /> H00009ld•> <br /> WRTER. 4!.>0.00 . ":� <br /> H00030877 s ''�rc�G"` <br /> ,.,1�� <br /> SEWER �70.00 -. �,f `'�,x., <br /> S'JSDEV i1884,Q0 " ''� ? <br /> EFIDSII 93?O,C� ; i,� <br /> � �� �� CyECf; 94077.SD �,' �a� <br /> ACKNOWLEDGEMENT OF CONDITIONS � t �T � <br /> The undersigned owner/applicant hereby agrees to hold and save harmless ,�, ����5, <br /> C� O� � the City of Everett from any and all claims for damages,costs,expenses,or �• +�r,u� <br /> causes ot action that may arise because of installation a�d maintenance ot r`�,i.��t�,�eai. <br /> Approv dforConstruction Dae theimprovementorotherright-of-wayuseheretoappliedtorandfurtheragrees },�•h {" <br /> to remove same upon notice from the City and to replace public property ` }:� �� <br /> 5: ` x <br /> �_ l�� g,� damaged there6/;{. , � "�L <br /> / � , F 1 � <br /> FINAL INSPECTION Oate � �; ,�� � <br /> Approved as Constmcted /- -l� '!`1� , . <br /> Signatureof licant Date _- 9 - <br /> �.� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE�WRFIIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO . � <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPGN ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. � <br />