1717 RUCKER AVE 2016-01-01 MF Import

Date��'J O r�oi��wo,..r«�mn oiaa oeni • — Applicalion For PUBLIC WORKS PERP.�IT °°°°°W°�"`�° -- Totnl Fae S Less�PO� fnoPxN s Ba�nnce Oun S Print or Type Only <�; ,a;,►-; �;;;�':�; 171� �l d''�`�'t" �1 }�t�" �[� I o��"�3�0 Owner Mailmg Address•�T Gly Lp Phone �qpP��A�� Mailing Address Cny Ln Phone Describe Proposed Work ��.j� � � ��` ^"`�--- W Projecl Address Uf known) �---l—l�—��t�� Atlach lour 14)copies ot plans lor proposed�r+ork- Draw to scale and note the following as applicable: � • Properry Lines • Centerline of street � • Oulline and dimensions of all existing and • InAicale Norih proposed slruc�ures on ihe lot • Show any proposed grading changes • Existing and prcposed utilities • Show measurements � DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1.All calls for inspection shell be made 24 hrs.in adva�ce•phone 259•8810. � 2.All work shall be peAormed in accorda�ce wilh this permil and cu«ent City of Everett Design and Construction Standard_�and Specificaflons. 3.Celi Location Underground Service 48 hrs.before you dig.TOLI FREE NUMBER 1-800�424•5555. � i'�'T ��-"� � ��-g8 O ,�� � � O a AGKNOWLEDG[MENT OF CONDITIONS The underslgned ownedapplicant hereby agrees to hold and save harm� less the Gty ol Eveiett Irom any and all claims lor damages, costs. expenses, or causes ol action that may arise because ol installation and maintenance of Ihe improvemenl or other nght�o4way use hereto applied for and lurther agrees to remove same upon notice from the Approved lor Construdion Date City and to replace pubhc preperty damaged thereby. fINAL INSPECTION Date Date Approved as Gonsiructed Signature of Applicant WORK AUTHOFIZE� BY THIS PERMIT MUST BE STARTED WITHIN everelt PUBLICWORKSDEPARTMENT 7g0 UAYS OF UATE PERMIT IS ISSUED AND THEREAFTER IS TO � 3200CetlarStreet BE DILIG[NTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE F.verett WA90201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Phone:259�8810 PROJECT OVER 90 DAYS DURATION.