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Date 2'2`95 <br />Application For <br />PUBLIC WOR�S <br />Print or Type Only <br />�'�9�ilNG 1.�,�y, <br />f,d <br />PERMI�' <br />� <br />d <br />0 <br />r.� <br />r ���oni�i 'c�iv`�i <br />o_ <br />� ait-�oo +r�cr. <br />�^ w o ,u ,-� „a t,i t:� <br />+ u> ba �a a� •O <br />C,I ¢9 ba. <br />Ralph Schuck 15621 Olc Mill Rd Snohomish <br />O�wier <br />Owner <br />Applicant <br />Desr.ibe Proposed Work <br />Mailing Address <br />Mailin9 hddress <br />new house <br />Lot 11 of 112th St <br />Proiect Address �if known� 11108 17th Court W _ <br />82@0 334-0817 <br />� ��y c� �- <br />p(_n CJ J_ c:� ]'_' j <br />no rur,of..��--� <br />O I J W.-JGLG: <br />Yt fCi G_ X� w� Gt <br />Attach four (4) copies ol plans for proposed H�ork - Draw to scale and note the following as applicable: <br />• Pro�ertY Lines <br />• Outline and dimensions of all ezisting and <br />proposed structures or ihe lot <br />• Existing and propose.i atilities <br />RS 05.� , <br />Pub4c W0&5?e�ml� a � � <br />Biaq Deo�. • 46901 <br />Pubhc YlorY.s Fco <br />To1al Fee $ _ <br />Less Aool. Fee Pa�tl � <br />Balance Due $ � <br />Phone <br />Phone <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 nrs. in advance • phone 259•8810. <br />2. All work shall be pe�formed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />L Xeep ci!}� streets clean at :dl rimes. <br />�. Curb e�iii�r and sidewalk in tlie pla� are new arid undamaged, a�ry damage thcreio shall be replaced �i Uie <br />Jiscrction of the PubGc Wcil;s L�spector. <br />6. A�ry change in �hc drivew;+v cnt rnust be approved by Nie Public \Vorks Tnspector, width at prop line <br />GuiileJ lu exisliug ,iprou wi�pi. Drivrwsj' IIWY I8�)CI �I�IIUBUV la wrct g81:I�C lIOUC CIIU;uice (for mi <br />srpro��cd 3 c,v S,uage). <br />%. �djusl water boxe; ro grade at end ot consln�ction. <br />�. Lots 5 Uuu 12 �hall �isd�argc roollop drwiagc to U�e stonn draui �tub providcd to thc lot. <br />9. I_otc 1 ihni 4 sleill di�ch;uge rooftop drainagc to the lots intiltration hench as per the'Dispersion Trench <br />uctaiP' on ,heet � ot ihe pints constn�clioiu pl�ui,. A preconsiruciion meeiinK must be scheduled witL Al, <br />Loc4x (3ES-9G55 mob. or L59-SS10 ailicc) prior �o insiailatiou of ihc u�fdlrafion system. My cl�angc in <br />ihe inti!lration Irenr.h tnusl be approved hy Ihe Public �4'nrks �uspector. <br />ACKNJWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />a <br />The undersigned ownn,r/applicant hereby agrees to hold and save harm� <br />less the Ci;y ol Everetl from any and aii claims for damages, cosls, <br />expenses, or causes ot action ;h:[ may arise because o' installation <br />and main�enance of ihe improvemen� or other right-ol�way use hereto <br />applied foi and further agrees to remove same upon notice Irom the <br />City and to replace public properry damaged thereby. <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98207 <br />Phone:259-8810 <br />Signature �Applicant `� Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENT�Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />