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-� - - - -� 5 -(, -Z8•-5 <br />Date�y5 <br />Appli;ation For TO PQ,STING � I <br />PUBLIC WURKS PER�AIT <br />0p <br />f� �. <br />Pfint Or Type Only r "`:"""' g G� <br />� ,o �-; o o� o o�o <br />,..,i .� � .a � .n rR r. m <br />Paul Bustard 1373 Blackcap Alley � �amano Ie 983�2 "� <br />OWOP.( <br />qpplicant <br />Describe ?roposed Work <br />MaihnG Ar,JreSs' `r .y� � dy' a; 'R r? r.: Zi <br />6.! O O (� S('1 7. � b 1i.1 h <br />t.. U Gl G:� [_I O LJ e-+ b-2 � <br />\ O_J _I Ii1 .I .r: fr_' O 1�1 <br />.p .Y.. G� O_ r j�i [A f.p .^.e ul N <br />M:�iLnq AddrC,s <br />Nv house — Baeic 164 <br />Prolect Address lif knownl _ 6423 Highlar i] <br />Lot <br />Pubhc Wods P.rmi� a �� �� /. <br />Bing Den� • 48445 <br />o„���� wo,., F�� S <br />ro�,i «e <br />�ess noui °�e Fa,o S _ <br />Bawnce Dua S ��__ <br />rn <br />0 <br />"'387-3120 <br />ZiP <br />AtteCh lour (4) Copies of Plans tor proposed wu:k � Draa: t� �cai�� ann ncte ih,+!o�luwing as aPU�ieable. <br />• Properry Lines <br />• OutlinE and dimensions o1 all exlshng anA <br />proposetl stmctures on the lo� <br />• Existing and proposed utilities <br />• CeMerlinr. ot Siree� <br />• Intlicate North <br />• �huw any r.ro�oseA c�raclin� r,hanga5 <br />• Show measurements <br />Nnone <br />Phone <br />35-94 <br />PERMIT CONDITIONS <br />1. All calls for Inspsctlon ahall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shNl be peAortned in accordance wlth this permit and currant City of Everett Design and Conetruction <br />Standards �nd SpecNicetlona <br />3. Cell Loc�tbn Underqround 3ervice 48 hra before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />4. Rooftop drainege sbell be diecharged: <br />• To tl�e eiM's atortn ckain eyetem (private or public) <br />• To a nridentiel roof downspout eyetem designed per section 4-9.4 of the <br />city �andarda <br />• OnM splaeh blocke <br />'Ibe metl�od eelected will be subject to Public Wodce Depmtement a�pproval. <br />Approved as Constructod <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett. WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The unders;one� owneriappiicant hereby agrees to hold and save harm� <br />—� less Ihe City o� Everett Irom any and alt claims for damages, costs. <br />� e*pense,. o� causes ol action Ihat may anse because of insiallation <br />; anA maintenante n1 tne imU�ovement or other right•oFway use here�o <br />Ii;,pl�n,; tor and lurther a9rees to remove same upon notice from 1he <br />Cdv ayq tn �eQlaca oy1�c pr�erty damaged thereby. <br />� ] � <br />\VOR'rC i��17HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAV BE <br />GANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />