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Date 2—z-95 <br />PUBLIC <br />Print or Type Only <br />Ralph Schuck <br />—��� <br />QWfiBf <br />Owner <br />Applicant <br />P o osed Work <br />",, F��t�:ilt�G a' I-�� <br />Application For <br />WO;RKS <br />J <br />r'� r -i - : r �� � :i <br />�-. ri <br />,.; �� , . <br />n_ <br />r'� � <br />15621 Ok Mil'T, Rd <br />PERMIT <br />i-i <br />Gi t f_ _'"� f f'� CJ f�r C,.I <br />C:� V'� r' ��: �i ih r'i 4� r] C., <br />- n r� r'n U �� •� • <br />rl li ��i ��.o . `.'i rJ i � <br />:. . . . .. I:'� r . <br />iisti; 98290 334-0�177 <br />,ddress � � "' <br />f 1 l�l -� ('i I. ♦ lJ fl (�I <br />:': f.l i C ;' G f � l <br />._I J I�l 1 '. � <br />O] �, 3_ �. US t..i _ . . <br />Mailing Address <br />new house <br />�iry to z <br />.I_ O:l I., .. <br />ilil( <br />��J I <br />f_ fi <br />City <br />� <br />g' ��3 � <br />Public Woiks Perml� • <br />6idg. DePt • <br />46897 <br />Puelic works Fee 5 -� <br />Tolal Fee <br />less Aooi. Fee Pa�a S � <br />r&+���W@.4�Ei _5�— <br />r] .:I� O tr. <br />.. ' i--1 • <br />Zip �-'' _3 .... <br />r� r� -]:- rn T—> i.-� <br />'l (1. C1;.1'.I <br />J 1.1 <br />LI1 �_�5.. I.. flA 1:`l f�J <br />Zip <br />Phone <br />Describe r p <br />Lot 3 of 112th St SW Estates � <br />prole�� Address (if known) <br />iiizi t�rn co�rc ta <br />Attach tour (4) copies ot Pl�ns for proposed work - Draw to scale and note � Ce^�,erl�me of stPee� able: <br />• Properry LineS • Indicate North <br />• Outline and dimensions ot all existing and e Show any proposed grading changes <br />proposed structures on the lot � Show measuremenls <br />• Existing and proposed utilities _ <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 2A hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance wilh this permit and current Ciry ol Everett Design and Conslruclion <br />Slandards and Specilications. qg <br />�; Call Lo�etl � �I�d?��9�°�'S hccan ��i all tltli,before you dig. TOLL FREE NUMBER 1•800'424-55 • <br />�, Curb �d�er :md sidewal�. in ihe plai are new and undamaged, any damage thereio shali be repiacecl at Ihe <br />discrction of li�e Pub6c «'orl:s Lispuctor. <br />6. r\�rv ch�+nnr. in the drivewrty cut must be approved by ihe Fublic Works Tnspector. width at prnp line <br />IIIIIIICII IU CY15U11� 8�11U11 WIIIIII. nIR'CWBy III.Iy ���)Cf �181�U:1�y �0 IIICC� �;U��C (IOOI' CI�Il-�lll'� ���f 81I <br />sppro��cd 3 car g;�rage). <br />,. Adjus� water boxes to eride at cnd of consin�ction. <br />S. Lots 5 llnu 12 ;h:ill �i�cleug� IGOI�U�I (iC�LL1�bC 10 UN s(otm Jrau� �hib providcd to tl�c lot. <br />� 1_ot: 1 ILni 4 �h:�l disch,ir�e rooHop dr�ina�c to the letc inliltratinn trench a� per the '71i�persion'Prench <br />Detail" 011 ti�ICCt � Of IIIC �)Iil[5 CORSIIiICh0I1S �lI�I15. A�lfCl'OIlS1ILCU0l1 IOC��llIQ IllUSI I7B SCIIC[I11I0(I \V1lL AI <br />Locl;c (?SS-96�5 mob. or 257 �;S10 ofii�rz) piior ro iustollatiou of 1}ie ailillratimi system. Nry changc in <br />Ihe intiltralion Ir�ncli mnsl he apprm�rr! h�• the ('nhlir. \Vorics fnspeclor. <br />qpproved as Constructed <br />PUBLIC WORKS �EPARTMENT <br />�� �� 3200 Cedar Slreet <br />[veretl, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEOGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the Gry of Everetl irom any and all claims tor damages, cosls. <br />expenses, or causes ot action that mzy arise because o( installation <br />and maintenance of the improvement or other righPof•way use hereto <br />applied br and furih� c9peepe�°yrda oVged herebyn notice trom ihe <br />CitY a��� reP ace p�q � �� <br />V � "' Date <br />Signature f Applican� <br />WORK A� THORIZED BY THIS PEPMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE f'ERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED T� COMPLETION. THIS PERMIT MAY 8E <br />PROJECT OVER 90 D YS DURATION. STOPPAGE OF WORK ON THIS <br />