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Date��5 <br />Application For <br />PU6LIG WORKS <br />Print or Type Only <br />Ralph Schuck 15621 Ok Pii11 Rd <br />Owner <br />Owner <br />Applicant <br />Describe Propo�ed Work <br />�� p�?S�T��� <br />PERMII� <br />YC <br />¢ <br />r,i <br />[� <br />C] <br />r <br />v] <br />�, � <br />fl <br />Snohomish 982 <br />Mailing Addres, U< `CrE� <br />0 0 <br />p� O <br />\ O <br />�,: 4 <br />Mailin9 Address City <br />new house <br />Lot 12 of 112th St SW Estates <br />ProjectAddress�ifknown� 111.04 17th Court W <br />��ZLj��S�l <br />o r� o 0 o c� ck <br />1q040 b'J C] r_. <br />T Mi O O �:r O I� <br />� at � r� i� {.1 ..a <br />i .,� <br />Ui Ll <br />334-0817 <br />c� �io, <br />r� cozco�. �� <br />C:� fi� C� G? f 1 �-i I�J <br />.J _.J li 1.. I Gr: IY_ <br />f�l (..0 ui U� f} GJ <br />Zip <br />Attach four �4) copies ol plans (or proFosed work - Draw to scale and note the following as applicablz: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposetl structures on the lot <br />• Existing and proposed utilities <br />�uOLc Warks Pmmil + ��1 �_��__ <br />aiae o�oi.. _46402 _ <br />P�pL� Works Fcc <br />Totai fce g ___ <br />Less Rppl Fee Pmd $ <br />Balance Due S � <br />• Centerline ot street <br />• Indicate Norih <br />• Show any proposed oradinc� changes <br />• Show measuremenis <br />Phone <br />PF_HMiT CUNDIT'JNS <br />1. All calls ior in�pection shall be made 24 hrs. in advance - phone 259•8$10. <br />2. All work shall b� pedormed in accord2nce with 7his permit and current City ef Everett Design and Construction <br />Standards ant Speci(ications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NU'.NBER 1•800-424-5555. <br />�i X_�n�P city street� cle�an at all tinles. <br />�. C'tub Puu�r and sidewalk in th:; plat ;IIC IIL'W :10(I UO(I:IIII;I�CfI. 80}' fl;uua��� ihercio shall bc replaced at the <br />discrciion uClh� Public tBoi1;: Li�pcclor. <br />(>. An}' cli�n_r,e in the dtivr,tvaV cid nui;t be npprovcd by thc Pubiic Worl;, Inspector. widlh �I prop line <br />Giuilcd lv eziatiu� aplou �vid(L. Ulivcw;ry ur,ry taper �taJually Iu iucel p�:ua��� duui r.ul�;wa (fm au <br />:q?pro�'ed 3 car nsr7Ee). <br />Adjusl w;�tcr hoxes to L�radz at cud ol conslnrelion. <br />S. Lul� s iluu 12 sLall clischarg� rovftop dr;w�agc to U�e stmm dr.vu ,lub ��ru�idcd t,-, Ihc lot. <br />� Lots 1 thn� 4 �h�ill dischnr�e roatlop drtinane to thc lots inliltration trench as per �he "Dispersion'french <br />iieiail" un shcet i or the plais con;in�ciions pl;ms. A precon�tniciion mcetine, mus[ be scheduled with Ai� <br />1_ocl;� (:�S-9G55 uiob. oi '_s9_SSI�� otrce) priorto uislailafion ofihe infillrn(ion �•atem. Any change iu <br />Ihe inlillr�tinu h rnrii mue� he ;�pproved hy Ilic Pnblic 1�,�orks Inspector. <br />I� <br />FINALYNSPECTION <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8810 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />0 <br />The undersiyned owner/applicant hereby agrees lo hold and save hamr <br />less the City o' Everett Irom any and all claims for damages, costs. <br />expenses, or causes ol action that may arise beceuse of installatia� <br />and maintenance of lhe improvement or other right-ol-way use hereto <br />applied for and further agrees to remove same up�n notice Irom the <br />City an^d to replace pu ic properry damaged thereby. <br />-� � � <br />�� ! <br />, �i,c.c. . ` _7G -/5 <br />Signature ApP icant �— Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BC STARTED WITHIN <br />�80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEf7M1T MAY BE <br />CANCELLED BY' THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRGJECT OVEH 90 DAYS DURATION. <br />