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i <br />, � <br /> � '�"� dOSTINti �_� � --�-- ' <br /> ��r`%�� ApPliwtion For • . <br /> PUBLIC VAIORKS PERMIt� °aS8— l0-2'-56 <br /> 'rUBLIC WORKS DEPARTMENT public Works Pertnit ti _=L(�y�4Z—�-�— <br /> 3200 Cedar Street <br />� Everen,WA 98201 259•8810 Building Perrrdt M 5'��0� . <br /> NPE OR PRIN7 ONLY Public Works Fee$ 7.�� <br /> Loren Dorrah 2820 B T.incoln Way .ynnwood 98036 787-6700 <br /> p�� Mailing Address Ciry Zip Phone <br /> Curt Johnaon 337-4733 <br /> Applicant Malling Address Cfty Zip Phone <br /> Describe Proposed Work new hauco. p,X � � I <br /> Yi <br /> � <br /> i A�B � <br /> 3 <br />� PROJECT ADDRESS(ifknown) 10429 19th Ave SE Lot :!�SP IF�-96 _ � <br /> AHach(our(4)copies oi plans tor proposed work-Draw to scale and note the following if applicable: O <br /> •Property LJnas 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br /> �Centerline ot street •Indlcate NoAh 'Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BEIOW THIS LINE � <br /> PERMIT CONDITIONS: <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 Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4245555. � � <br /> 11/08/96 1�:46AM 0'JOAIk65 �X� <br /> / o ' <br /> 4t00053459 , <br /> ELEC ii10.00 � <br /> t4�00053303 <br /> ELDG 52255.00 <br /> PL£G 5154.� � <br /> 11ECN �1�9.00 <br /> SRCHRG 54.50 <br /> ��'IV6JV f20.00 �i <br /> q00009184 ; <br /> WpTER 5130.00 <br /> 400030876 � <br /> SE{�R 370.00 � <br /> S'�SDEV 51884.OJ <br /> SISDEV 5:;30.t10 <br /> �� D � ` CHEC1; 54077,50 t <br /> ACKNOWLEDGEMENT OP CONDITIONS � <br /> �`7 '��1 The undereigned owner/appiicant hereby agrees to hold and save hartnless , <br /> ��j� ///L�n I�/�/�///_ the City ot Everett from any and all claims for demages,ccsts,expenses,or ( <br /> �f i/( �CXX. Z�o causes of action that may arise because of installatbn and maintenance of � <br /> App vedforConstmctlon Date theimprovemeMorotherright-of-wayuseheretoappliedforandfuAheragrees <br /> ��/C��� e to remove same upon notice from the CNy and to replace public propertY ' <br /> -NwC/�� 'L%` ��, " ��� damagedtherebY. <br /> FI INSPECTIO Date � � � �/ �� <br /> Approved as Constructed � <br /> Signature of� plicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVER 90 DAYS DURATION. <br />