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5 - —�-z�-s — / <br /> � APPlication For <br /> PUBLIC WORKS PERMIT o<<e lzilzi9s <br /> PUBLIC WORKS DEPARTMENT pu��ic Works Pertnit 8 � V v I <br /> 3200 Cedar Street <br /> Everett,WA 9B201 259�8810 <br /> Building Permit N 507 AR � <br /> iYPEORPRINTONLY TQ oQSTING .�pY�� t996 Pub�icWorksFee$_�D� <br /> Paul Bustard 1373 Blackcap Alley Camano Is 98292 359-0860 <br /> Owner Mailing Address City Zip Phone <br /> Ownei <br /> Applicant Mailing Addreu Cily Zip Phone <br /> Describe Proposed Work New house - Basic 1111D <br /> W <br /> - H <br /> - <br /> PROJECTADDRESS(if known) 1604 Florida Dr Lot 4 S� 2�+ � <br /> Attach tour(4)coples ot plans tor proposed work-Draw to scale and note the following if applicable: � <br /> 'Property Lines �Outline and dimensions of atl existing and proposed structures on 1he lot •Existing and proposed utilities O <br /> 'Centerline of street •Indicate North 'Show any proposed grading changes 5how measurements � <br /> DO NOT WRITE BELOW THIS LINE Ol/16/96 2:liP?i OOORN�i01 �:K <br /> PERMIT CONDITIONS: <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of L��ign and <br /> Construction Standards and Specifications. �LDG s4B9•`HI <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM��1-800-�5. � <br /> "SECH SbO.OD <br /> SFCHRG 54.50 �/� <br /> 4. RooBop drainage shall ��e discharged To a residential roof downspd�$�tem gt0.00 ��� <br /> installed per city eta�idards. It�000304bR O <br /> ?. Fow•ofi's��eel (offeanemaut) P;irkinri sttills nwsl Le provided for ea�1�i� q��6A�nut � <br /> he more tha��ttco ca�s derp (ta��dem stall� bk'). CHECI; ��003.40 <br /> s�y� <br /> ��////// ACKNOWLEDGEMENT OF CONDITIONS <br /> ,�/A „�„ /��/� The undersigned ownedappiicant hereby agrees to hold and save harmless <br /> �� L��O� L the City oi Everett irom any and all claims for damages,costs,expenses,or <br /> Ap—p�d for Construction � �at causes of aclion that may arise because of installation and mainterance of <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> to remove same upon notice from t e City and to replaca public property <br /> — D dama here . <br /> LINSPEC � �� D e <br /> Approved as Constructed <br /> � r <br /> Signa ure Ap ' t � Da <br /> WORK AUTHORIZED BY 7HI5 PERMIT MUST 8E STARTED N'ITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY iHE CI7Y UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />