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Date <br />10(2/95 <br />PUBLIC <br />Print or Type Only <br />RALPA SCHUCK <br />Owner <br />Applicant <br />.� \ <br />Applicalion For � � V f�tJ 3I I 1'd � ��� �� �, <br />WORK�PERMIT <br />0 <br />O <br />C <br />r_ <br />a <br />n� <br />O <br />.-i <br />20717 36T}j, <br />\4aiiin�.� <br />PA:.'�In��q <br />� OO I�fIO <br />1fl ��� O .i� O <br />.-+ ,a ,u «. ca <br />M � � � <br />NW <br />U <br />�o <br />w <br />STANWOOD 98292 <br />L'l S 2 3 U�i}' <br />'� w <br />or�w�� x <br />r'"�.� n. z u� o � <br />Ci�y <br />Describe Proposed Work NEW HOUSE =,BASIC 1105__ <br />Project Address (il knowN <br />i�n <br />Zip <br />AttaCh toW (4) copies of planE fa qroposed wo:K � Drav: to scain ano ncle �ha lollowing as apphr,ahie. <br />• Property Lines <br />• Outline and dimensions ol aIl existing and <br />proposed siructures on the lot <br />• E�istiny and proposed utilities <br />Pubhc WorFs Pnrm11 a ���SV f—' <br />em� o�o� • —496�3-- <br />Pubi¢ Ylorks Fec 5 <br />,o„� F�� <br />Lras Anui Fnr• Pai] S <br />e_,i,�,�,�o���; 5 <br />652—I309 <br />• Centerline n� S(ree! <br />• Indir.a��: North <br />• Shov.• any r.ropoSeA gradinq r.hanges <br />• Show mrasurement, <br />PERMIT CONDITIONS <br />7. All calls tor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with this permit 2nd current City ot Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underpround Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />L Keep city streets clev� at atl tune,. <br />5. ::iUb �uter mid �idewalk u� U�e plat are ne�c and w�da�naged, atry dm�iage tlierzto shall lm replacz� at lite <br />discretion of tlie Fublic Works Inspector. <br />6. �� change in d�e driveway cut m�st be approved by d�e FubGc Works Lupector, widdi at prop Wie l�nited o <br />C;tl5[lll�; HOfGil WI(IIII. Dl7Vcway may laper q'adually to mee[ garage door enVm�ce (for m� approvcd 3 c:u� <br />F�ara��el. <br />�i�just waler Loxes lo e�ade ut enJ of cu�isi�uc6ou. <br />3. lli�7sio�i ? Lots lots 3;1,5 K 3�hall �isclitic;c roonop drtinane to the lot: infiltratioa trench as per the <br />"llispersiou 1'rench lletail" 0(1 SIICCC S Ot [IIC (1I8IS L'OI1S�11Cf10115 �II�lIS. A�I'ZCOOSl1Ul'I10�I IIlCCf1I1� (Il1ISi IIC <br />��Iltl(IIlIC(I W1tI1 tU811 LOL'IiC �3S3-9G55 mob. or 259iS10 otTice) prior to nistallafio�i of tLe infiltratiou s}�stem. <br />:lny cli;mge in tl�e uifiltration veuch must be npproved by tlie 1'ublic Wmks L��pector. r1ll otlier lots in <br />llivision 2;hall dischtuge roofto�� drainaee to the stonn drain �wb provided to the lot. <br />App�ove0 as Gonsirudea <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98207 <br />Phone: 259�8870 <br />I <br />i <br />� <br />AGKWOWLEDGEMENT OF CONDITIONS <br />/r� <br />id ♦ <br />O <br />a <br />ihr. under�igned ownedapplic2nt hereby agrees to hold and save harm� <br />less Ihe City of Everett irom any and all daims lor damages. cosls. <br />CKUe�5P.5. O/ Cd11SE5 O� cC�lOfl thai may aris= �)PC2US0 0� installa�ion <br />nnd inaintenance n! the improvement or other righPoi�way use hereto <br />apphn,, for and furiher agrees lo remove same upon notice from the <br />C��'v .ind to replace pi hc pronerty damaged Ihereby. <br />� � <br />Signa�ure I Applican� Date <br />4NORK AU7.NE1 IZED 8Y TfiIS PERMIT MUST BE ST1IRTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED PND THEHEAFTER IS TO <br />BE DILIGENTLY PURSUED ?O COMPLEiION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PRO.IEGT OVER 90 DAYS DURATION. <br />