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/ <br /> � APPlication For <br /> PUBLIC WORKS PERMIT oate_12/12/95 <br /> PUBLIC WORKS DEPARTMENT Public Works Pertnit# <br /> �r�tc�a8 <br /> 3200 Cedar Street <br /> Everett,WA98201 259-8810 BuildingPermitk Sn9AQ_—= <br /> IYPE OR PRINT ONLY ?��' POSTI N G MA.�—�—��� Public Works Fce S �� <br /> Paul Bustard 1373 Blackcap Alley Camano IS 98292 359-0860 <br /> Owner <br /> Mailing Address City Zip Phone <br /> OWneY phone <br /> Applicant Mailing Address City Z�P <br /> Describe Propos.:d Work New house — Basic 1111C � 1 1 <br /> ii� <br /> � <br /> � <br /> N <br /> PROJECT ADDRESS(i:;:��own) <br /> 1606 Forida Dr Lot 3 .SP Z�'QS � <br /> Attach four(4)copies of plans tor rtcposed work-Draw to scale and note the following ii applicabie: . <br /> •Property lJnes 'Outline ai:a dimensions of all existing and proposed structure:,on the lot •Existing and p 1��6J9�ilit1l 59FM IXIORN401 �kk <br /> 'Centerline oi street •Indicate North •Show any proposed grading changes •Show measurement� <br /> DO NOT WRITE BELOW THIS LINE, N00050289 � <br /> PERPAf;CONDITIONS: EtDG $489.`�0 <br /> 1.All .:alls for inspection shall be made 24 hours in advance- phone 259-8810. PLEG tt Dess6z.0� O <br /> 2. F�I�Nork shall be performed in accordance with this permit and current City of�� �Q� <br /> Gonstruction Standards and Specifications. SRCHRG 54.56 � <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM�0��;�-4�9:�• <br /> SEWEF. 470.00 N <br /> s. Rooflop drninnge shr!� be discharged To a resid�-ntia!roof downsp�►t9Q�Ytet»!^96.00 O <br /> instnllzd per city standar ds. CHECI: s2003.40 <br /> 5. Fuur ofTstreel (u$'ea+emeut) Parkiug el.dls nmsl Le provided for each w�il - �t�dl�may not a <br /> bc more than nvo car� de�.p (tandem ct.ills `ok'). <br /> Ul—' ' /k 5 ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save har—less <br /> / �� l/� the Ciry of Everett from any and all claims for damages,costs,expens .or <br /> < < causes of action that may arise because of installation and maintenar,�e of <br /> roved:�rConstructio���ate theimprovementorolherright-of-wayuseheretoePPliedtorandfuAheragrees <br /> � O� to remove same upon notice from the City and to replace public propeAy <br /> S�O/gG damagedthereb <br /> r -- <br /> F INSPECTI Dat� <br /> Approved as Constructed � <br /> Signature of Ap can a� <br /> COMPLEf10N TI�S PERMIT MAY BE CANCELBIEDTBYTHE CIN'UPON ANY SOOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DULRA170NLY PURSUED TO <br />