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Date 12-5-94 T� '' ��'���NU � � ����% <br />Application For <br />RUB�IC WORKS PERMIT <br />Print or Type Only <br />/ <br />Publ¢ WO�kS Peimi� ✓ �� �� / <br />Biap Deo�.+ 4fi36R <br />vuel¢ works Feo <br />To�al Fee $ <br />Less Ap01. Foe Pula g <br />Aalancc Oue $ <br />�` <br />Ralph Schuck 15621 OK Mill Rd Snohomish 98290 334-0817 <br />Owner Mailing Address City Zip Phone <br />nt <br />Describe Proposed Work <br />Project Address (if known) <br />Mailing Address <br />new house <br />11128 17th Court W <br />City Zip <br />Lot 7 112th St SW Estates <br />Attach four (4) copies of plans for proposed work - Draw to scale and note �he lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed siructures on the lot <br />• Existing and proposed utilities <br />• Centerline of sVeet <br />• Indicale Norih <br />• Show any proposed grading changes <br />• Show measurements <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 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 />4. b_rep cin� �heet� cle�n at all times. <br />5. Curb euher �uul sidewedk ui N�e plat are new anJ uudamagecl, arry d:unaoe thereto sh�ll be replaced ai ihe <br />discrction of the PubGc «'ort:s inspectur. <br />6 Am� change in the driveway cnt mnst bc approvcd by thc Public Works Tnspector. widih al prop line <br />IIIIIIICII W CX15II11�' J�)IUII WIII(II. DIR'CWJ�' 111;1)' lBNCf �-JliUillly (U IIICCI �.',LIfJ�,C 1I0U1' COlf;llll'C (POf ;111 <br />�ppra��cd 3 car g;uage). <br />Adjust water boxes to erade. at enrl o� consiruction. <br />3. Lets 5 Uuu 12 sh;�l Jischarge ruuliop driinagc to lhc slomt draui slub proviJcd �o th: lol. <br />9. Lots � thni �i �hall discharge rooftop drainage to the lots infiltration trench as per thc "7isperion Trench <br />Deiaii" on sheei i oF ihe pl,iis cous�nunons plans. A preconsin�ction mcetine, musi be scheduled witli Alan <br />LocLc (�SS-9G55 mob. or 259-SS10 o(licc) prior to u�st�llalio� of Ih� u�filha6on �}�stem. �irry chongc ui <br />�he intillration trench mnst he approved hv tl�e Public Wnrks fnspector. <br />%�G+�i���,� �����15 <br />Approved f onsiruction � Date <br />� O /' �� <br />fIN L N PECTION � Date ' <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />�J <br />The undersiqned owner/applicant hereby agrees to hold and save harm� <br />less lhe City of Everett irom any and all claims for damages. costs, <br />expenses. or causes of action ihat may arise because ol installation <br />and maintenance of Ihe improvement or olher right-of�way use here�o <br />aoplied for and further agrees to remove same upon notice trom the <br />City and to replace pub � prop rty damaged thereby. <br />� � � a.�_��, <br />Signature o pplicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEIi IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELI.ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />