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� <br />�pplication For <br />PUBLIC WORKS PERMI'T <br />TYPE OR PRINT ONLY <br />Ralph Schuck <br />Owner <br />Applicant <br />Describe Proposed Work <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 2 9-8810 <br />►�l�t�r <br />TC� �'05TING ---- <br />/ <br />Date z�21 <br />Public Works Permit N ��� ��� � — <br />Building Permil # <br />Public Works Fee $ �C� <br />20717 36th Ave NW Stamacod 98292 652-1309 <br />Mailing Address City Zip Phone <br />Mailing Address City Zip Phone <br />New house — Basic 1105 �_ ,�, ,��_ <br />�' C <br />PRnJECTADDRESS (if known) _� �% �2 � <br />5LDu �»1�..40 <br />CfE.7 y60.70 <br />Attach four (4) copies o( plans for proposed work - Dra�v to scale and note the following if applicable: <br />n��iYi���i ;^p,?� <br />ru� rv e� �.� on <br />•Property Lines •Outline and dimensions of alI exisling and pmposed structures on ihe bt •Exis�ing and proposed utilities� <br />•Centedine of sireet •Indicate Norih •Show any proposed gmding changes •Show measuremenls <br />DO NOT WRITE BELUW I F115 �iNt <br />PERh�IT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction utandards and Specifications. <br />3. Call Location Underground Service 48 firs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />d. kcep cuy ,�ree�, ciran at ;dl murs. <br />5. Ciub butter a�ut sidew.�ill: u� tl�e plat are new aud wtda�n�;;ed, airy da�nsge il�ereto sh�u be repLic�d st the <br />discreGon of'tl�e Public Works Inspector. <br />ti. �1��y cha�i��e in d�e cLiveway cut iuust be approved by d�e PuLGc 1'v'oik� Iuepector, widtL at prop tiu� liiuitrd <br />rxisticg aprm� width. ll�rvewaV m:rv tnper laduaih� ro mzet ^s�agc doo� culraucr rfo� :w appr�,vril ; c�.ir <br />f�araee). <br />?. Adjust watcr boxes to �ad� at cnd of construcrion. <br />8. Divisiot� 2 Lo[c lots 3,4,5 & S shall disct�arge rooRop rlrsin�. �e to fha lul� intiitr:dion trruch .0 per 16r <br />"Disj18IS10f1 C!'COl'il L�CI�II" 011 S'I10CI S OI WC 4)IJIS l'OIliIILLl10113 �llllil3. A(71C1'OI15LItll'110111t1�C1111;t, lllll;t br <br />sc6eJuled with :Uau Lockr (333•9655 mob. or 259-8310 officej prior to uist�llution of the aifiltra(ion sr.�:v�. <br />Any ch;uige u� Ihe 6dilU'ation tr�nch must be approved by tl�z Public Wml:s Lispector. All othcr luls iu <br />Ilivri:inn ) ch�ill dicrh�u u�� rnnRnn drninavc tn ih�� st0i7ll (If�ltl saib provided to �he lot. <br />W <br />� <br />� <br />V♦ <br />� <br />0 <br />� <br />Z <br />� <br />� <br />V/ <br />O <br />a <br />ACKNOWLEDGEMENT Of CONDITIONS <br />The undersigned owner/applicaN hereby agrees to hold and save harmless <br />ihe City of Evere�t from any and all claims for damages, costs, expenses, or <br />causes ot action ihat may arise because of installalion and maintenance of <br />Ihe improvement or other rigM-o4way use hereto applied for and luriher agrees <br />to remove same upon notice (mm the City and to replace public pmperty <br />damaged Ihereby. <br />U L <br />Signature App icant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGEfJTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANC[LLED 8Y THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 D.4YS DURATION. <br />