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2-9 <br />TYPE OR PRINT ONLY <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />� STING M-- 1996 <br />Date Z-9-9672 <br />Public Works Permit It 0 [ 3 <br />Building Permit s 502[ O _ <br />Public Works Fee $ l..C/ <br />_ Paul Bustard 1373 Blackcap Alley Camano Is 14A 98292 360-651-2172 <br />Owner Mailing Address City Zip Phone <br />Owner <br />Mailing Address <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />new house <br />Lot 25 Maple <br />aDiv 2 <br />4S23 seaiiuok <br />03/07/96 3.%PH t%1t1GU477- <br />1100050840 <br />e1.E0 %96.00 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: SgCNFU '$+,50 <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot -Existing and pry 6M.1utllitieS10.00 <br />'Centerline of street 'Indicate North -Show any proposed grading changes •Show measurements c-LN CH $5, 20 <br />n <br />PERMIT CONDITIONS: tkATO $650.00H0003057.9 <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. -EWE9 170 <br />2. All work shall be performed in accordance with this permit and current City of Fy, D ig <br />Construction Standards and Specifications. gSlg%a <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM9Ek1-80t)-424-5555. <br />Roollop drainage shall be disehltr,pd: <br />• I'o the site's stornl drain system (private or public) <br />• l'o a resid,uliBl roordowltspoul system desig7ed per section 4-9.4 orlhe <br />city st:uldards <br />• Onto splash blocks <br />The method selected will be subject to Public Works Ueptirtenlent approval. <br />lac- <br />W <br />V♦ <br />0 <br />z <br />0 <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />< The undersigned owner/applicant any <br />and a hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />I Approved foWjnsN cti Da a causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />eda Datu <br />Approved as Constructed - 3 <br />Signature of ApplidtlFt il ate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 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 UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />