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Date_5-/26/95 <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />PAUL BUSTARD <br />Owner <br />1373 <br />Mallory <br />TO POSTING - <br />PERMIT <br />I!Y <br />Applicant r,'.,�bna Address <br />Describe Proposed Work ___ <br />Project Address tit known) <br />f <br />"b" worts ""I <br />noo Deol e <br />RAJ¢ WorMe fee <br />Total fee <br />Left APPI fee PA A 8 <br />exience Due If <br />LLEY CAMAItO IS 98292 387-3120 <br />rlii cc'S�L + 5 yr5�,' Zln Phone <br />try ui <br />8i h�74`! o$I1r+Fn to <br />City Zip Phone —_ <br />NW HOUSE - BASIC 164 <br />---- - 2320 75th St BE�— - - <br />Lot 2 Short Plat <br />Attach four (4) copies Of plans tot proposed work - DIA . in er.al, •wn nit- me following as applicable <br />• Property Lines 0 Canterline of street <br />• Outline and dimensions of all existing and • indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Shnw measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3, Call Location Underground Service 48 his. before you dig, TOLL FREE NUMBER 1.800.424.5555. <br />q, <br />Pr vide, i1 ton MJM O'f 4 c- A"tt- <br />VitrJ\IVTr1 <br />IStd <br />SLAMS <br />5, <br />Ares;deLTti�l s��r �KIe�SJsEt+� I9elr <br />NrPA <br />reV,; red n Ch; s fxvX, <br />Approved as Constructed <br />Cff PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 2E9.8810 <br />IT <br />t <br />q <br />Ch <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages. costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of•Way use hereto <br />;ig2nature <br />for and further agrees to remove same upon notice from the <br />eplaces public pe damaged thereby. <br />an ate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLtiD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />