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� <br />� <br />�� <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everutt, WA 98201 259-8810 <br />Date 8-5-96 <br />Public Works Pertnit #_ /�/� r � <br />Building Permit R _ 52483 <br />TYPE OR PRINT ONLY `�N � Z� public Works Fee $� <br />TO POSTING ----- <br />Paul Bust:ard 1373 S John St Camano Is WA 9R292 387-3120 <br />Owner Mailing Address City Zip Phone <br />Owner <br />Applicant DAailing Address City Zip Phone � <br />Describe PropoSed VVork <br />PROJECT ADDRESS (if known) <br />new house <br />��s 54th St SW Lot 3 SP 1136-95 <br />Attach four (4) c�pies of plans tor proposed work - Draw to scalo and no•� `ollowing ii applicat,le: <br />•Property Lines 'Outline antl dimensions oi all existing and propos�� structures on tl��e Iot •Existin� and proposed utilit� :s <br />'Centerline of street •Indicate North •Show any proposed grading changes •Show mec�surements <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 o <br />Construction Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM��-424-5555. <br />BLOG 5561.50 <br />4. Rooftop drainagz s6aU be discharged to the luta infiltrat�on t as p���city's <br />"ReddentLel Roof �ownspaut 9jr�tem" detail and as per the 1 inf ion on <br />ti�a 1�,Y� �it� pta�. e1.�y change in the inRltrat�on trench murt ra the <br />Public Works ]nepector. CeII tor inapecdon �prlor to covering. p�p � t3,71 <br />M000090'!" <br />YpTFR s105.00 <br />M00p30769 <br />SEWER 570.00 <br />SY90EV 41296.00 <br />CF�pC 9�203.71 <br />Ij <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLEUGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby a9rees to ho�d and �ave harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may anse because ot installation and maintenance of <br />the improvement or other right-of-wa/ use hereto applied for and turther agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />� Date <br />�Signature of App ican <br />OAiP ETION.T�HIE.4 P RM T MAY BE CANCE BLEDTBY THE CINIUPON ANY S�TOPPAGE OFrWOP.K OSN THIS PROJEC 0 EER 90 A S DULRATIONLY PURSUED TO <br />