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Date Z`2'95 <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />Ralph Schuck 15621 Ok Mill Rd <br />Owner <br />Owner <br />qpplicant <br />Describe Propoted Work . <br />Project Address lif known) <br />�����STIN6 Z-7 - <br />r'� <br />PER�IIT <br />tS <br />O <br />� � o 0 0 0 0 <br />y � o a o� g o <br />� o,r:,pri�or- <br />;':i ..v'r�«�'su'�*"'�� <br />�� � <br />Snohomish �8290 334-0817 <br />Mailing Atltlress <br />new house <br />Lot 5 of 112th St SW <br />11126 17th Court <br />� �u Citv v � .:c <br />pc� '�x co x� r� <br />OG�CtIG.I p („7H W <br />OJJ W .-1 icCi= <br />st W 0.� G] N Q[..1 <br />Citv <br />tes <br />LI�I <br />`��-i <br />Pu�l¢ WoMs Permil a � <br />eiay o�a • 46898 <br />Public Ylorks Fee $ <br />Tolal Fee <br />Less Appl Fee PaiC � �/ <br />$ �V <br />Ba�anre Due <br />Altach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all exisling and <br />proposed structures on ihe lot <br />• Existin9 and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />f�none <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 wilh this permit and current City of Everelt Design and Construclion <br />Standards and Specifications. <br />3. Call Loq�tion U.nderground Service 49 hrs. before you dig. TOLL FREE NUMBER 1•800•424•555 . <br />q. KCt[! Cl�j' Slrects claan at all hmc�. <br />5. Curb euiier anJ sidewalk in ihe plac are ucw :uid undam,�"zd, �n}' damage thereto slmll be replaced at ttie <br />Ji:crctiou of tlic Pul�6c �t'od:s Lupcctor. <br />6. A�ry chanee in thc d�iveway cn� mnst be. apprnved by the Yublic Worhs Inspector, width at prop line <br />IIIl11IClI IO CXISIl11K ��11U11 WIIIIII. DIR'CW�Y 11187' Iap�r yadu:dl>' lo ui�C� Ki118�'C (I00( CR�f�flL'C (�OI' au <br />�pproved 3 r.0 g:u:�ge). <br />;. ndjust waier bnxes ro erade at end ot constmction. <br />S. Luts 5 Uuu 12 ,Irali Jisch�ugc roo(iop clraui.�gc to thc alunu Jr;w� �tul; Pro�i+lcd lo thc Iot. <br />9. Lots 1 thni 4 shall di�ch;uge rootiop drtin�gc to ihc lots infiltratioii trench as per the "Uisrersion Trench <br />Detail" ou shcei i oi� ihe plais cousmictions pl;ms. A proconsiniction incrtu�? must be scheduled wi�li `11 <br />Locke (3S8•9655 mob. or ?s9�SS10 of('ice) p�ior to installation of Il�e infillralion s}'stetn. .1�ry' �f�a��6� u� <br />thr, inliltrdinn Irench mnst be appmved Uy Ihr. I'uhlic U�orks Tnspec�or. <br />� <br />Approved as Consiructed <br />PUBLIC WORKS DEPARTN�ENT <br />3200 Cedar Street <br />Everetl, WA 98201 <br />Phone: 259�8810 <br />Date <br />Date <br />ACKNOWLC-DGEMENT OF CONDITIONS <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hoid and save harm- <br />less the Cily of Everetl irom any and all claims for damages, cosls, <br />e■penses, or causes of aciion that may arise because of installation <br />and maintenance ot lhe improvemenl or other right-ohway use hereto <br />applied for and further agrees to remove same upon notice irom the <br />City and to replace public property damaged ihereby. <br />0 ��r � ��- �n a-i[�-�s <br />SignaWr f Applicant � <br />80RDAYS OF� DAT�E PERMIT SESSUED AND THEREA�TER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEGT OVER 90 DAYS DURATION. <br />