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Date 2-2'95 <br />Application For <br />PUBLIC WORKS <br />Print or iype Only <br />Ralph Schuck 15621 Ok Mili Rd <br />Owner <br />Applicant <br />Descr'be Proposed Work <br />Projecl Address (if known� <br />i0 PO�TING <br />� <br />PER�IIIT <br />Q <br />� <br />a -z� -qc <br />� N � <br />m o m <br />in «� <br />N.� � <br />Snohomish �8290 <br />MaitingAtldress o:� <br />\ <br />� <br />.-i <br />CJ <br />Mailing Address <br />new house <br />Lot 6 of 112th St SW Es''a <br />11130 17th Court W <br />o4�oa <br />oo.�or%• <br />����� <br />MT <br />334-0817 <br />Gfly [7 ti <br />cn[9 z�' i3G� <br />�(�] UQCJ�+W <br />W d� CG Ul 0 V <br />Ciry <br />/ <br />/% / �� <br />Public Works Permlt < "� S/� <br />aio9. oen�. • 46899 <br />I Publ¢ Woiks Fee <br />� Tolal Fee g — <br />LLess ApPI Fee Pmd g— <br />a,�a��e o�� $ � <br />Zip Phone <br />Zip <br />Attach four (4) copies ot plans lor proposed work - Draw to scale and nole the following as applicable: <br />• Property Lines • Cen�erline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on Ihe lot • Show any proposed grading changes <br />• Existing and proposed utililies • Show measuremenis <br />LINE <br />PhOn@ <br />PERMITCONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Consiruction <br />Standards and Specifications. <br />�Call Lo �ation Underground Service 4�g hrs. before you dig. TOLL FREE NUMBER 1•800-424-55.�i5. <br />�. �_ecp cih� . treets clr.�n at alt times. <br />i Curb euiter and sidewalk in the pla[ are new and undur�aged, am� damagc diereio shall be replaced ai ihe <br />cliscrcliou of ihe PubGc \'.'orks H�spector. <br />!> Atry cl�anee in the driveway cut musf be approved by the Pubiic Worlcs Lispector, width al prop lu�e <br />IIIIIIIt:II IO C7(ISIIDF� 8'11U11 WIIIUI. .DIIYCW�Iy IIIII}' I8�)CC �A�(Ill.11lj' IU IIIGCI �81:IgC 1I00C �IIII:IIICC �P01 8l1 <br />;ppro��ccl 3 ctu i;.uage). <br />�, ndjust water boxes to �ade at end oF comhuction. <br />o. Lots 5 Uau 1Z shall Jisch;ugc ruotlop �iauwge lo Ihc �tonu drain stub pro�idcd to Ihc lot. <br />9. Lots 1 Ilnu 4 shall discharce rooflop draina�e in tl�e Io1s intiltration Irench as per Ihe "Disper�ion Trench <br />lleiail" on sheei i nF die plais consiniciious plans. A preconslniction meeiu�v must be scheduled w•ith AI <br />Locl;� (3�5-9655 mob, or 257-SS10 officc) p�ior lo uutallaGon of iLe infiltration systcm. A�� climtge in <br />thr intillratinn trench must b� appro��ed hy ihe Public Works Tnspector. <br />r <br />/ , <br />Approved as ConsVucted <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />Date <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ol Everett Irom any and all claims for damages, costs. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of ihe improvement or other right•oi-way use hereto <br />applied lor and further egrees to remove same upon notice Irom the <br />City and to replace public property damaged Ihereby. <br />_�l ��� �-- /G -�i s <br />Signature, 1 Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY 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 />