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Applicatlon For / <br />� PUBLIC WORKS PERMIT Date $-5-96 _ <br />PUBLIC WORKS DEPARTMENT Pubiic Works Permit p_/ Z I ._ <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />AUG 0 4 1997 guilding Permit p 52482 <br />7�� Q�STING - <br />TYPE OR PRINT ONLY Public Works Fee $�� <br />Paul Bustard 1373 S John St Camano Is WA 98292 387-3120 <br />Mailing Address <br />Owner <br />Mailing Address <br />Describe Proposed Work <br />new house <br />PRO,�ECT ADDRESS (if known) <br />623 54th St SW <br />Zip <br />Zip <br />Lot 2 <br />Attach fo�.ir (4) copies of plans for proposed work - Draw to scale and note the following if applicable: �,�� <br />•Property L1nes 'Outline and dimensions of all ex!sting and proposed structures r� the lo[ •Existing and p�d utiliti��� <br />'Centerline ot street •Indicate North •Show any proposed grading chanaes •Show measurements �� �� <br />DO NOT WRII E BELOW THIS L.INE <br />PERMiT CONDITIO!i;:,: ��1 �•`� <br />1. All calis �or inspection shall be made 24 hours in advance - phone 259-8810. ��� V-4.50 <br />2. All work shall be pertormed ir accordance with this permit and current City of �Desi�r� <br />Construction Standr,rds and Specifications. <br />3. Call Location Underground 3ervice ;8 hrs. before you dig. TOLL FREE NUNR�S424.5555. <br />105 OD <br />MOOA30751 <br />4. RooRop drninage shal! be discharged to ihe lots Intiltration tr p�r�qa� city's <br />'Residential Roof Downspout 9y�tem" detell and a� por the to�n i�fp�lon oa <br />the lot's dte p]an. Any change in tUe in�ihation trench must be approved b� the <br />PublIc Works [napectoe. Csll for inspection prior ta cavering. <br />� //-i 1 -�` <br />uate <br />Approved as Cnnstructed <br />� <br />a <br />/�� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersinned ownedapplicant hereby agrees to hold and save hartnless <br />the City of Ecerett (rom any and all cl::;ms for damages, costs, expenses, or <br />causes ot action that may arise becn.;c of installatlon and maintenance of <br />ihe imprrnement or other righbo4w�i use h=reto appliod for and further agrees <br />to remove same upon notice from e Grty and to replace public propeAy <br />damaged there . <br />_ ���- <br />Si nature o Ap lica p <br />9 P � ate <br />�l <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND TI�REAFTER IS TO BE DILIGENILY PUFSUED TO <br />CU"4PLETION. THIS PERMIT kAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER /9�0 DAYS DURATION. <br />��U /�/ads ..�s <br />