2619 RUCKER AVE 2016-01-01 MF Import

Date 8�� V ' v,�oi,�wo��sr",90 25414 o�ae.oeoi.. � Application For PUBLIC WORKS PERMIT '°°"`W°'�„�° _ -- Totnl Fee Less Appl Fee Pm� a paiancr o�c � Print or Type Onty 2619 Rucker Eve=ei:t 96201 252-9582 Owner Mailin9 Address (.'tY Zip Phone Owner Applicant Mailing Addr=ss City Zip Phone Describe Proposed Work 8— t W Prolect Address(if known) 2619 RUCker � Attech lour(4)copies ol plans lor proposed work• Draw lo scale and note the lollowing as applicable: � • Property Lines • Centedine of slreel � • Outline and dimensions of all existing and • Indicale Norih proposed siructures on the lot • Show any proposed grading changes • Existing and proPosed utililies • Show measurements M W DO NOT WRITE BELOW THIS LINE O PERMITCONDITIONS � 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. 2.All work shall be pertormed in accordance with this permit and current Cir;of Everelt Design and Construction Standerds and Specificetions. � 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-500•424•5555. O Y��,t=��1 L \�/c�.�S ��oT �� � �Vl� �. N 1 c��. �-� _ � � - Z� -�° a ACKNOWIEDGEMENT OP CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City ol Everett irom any and all claims lor damages, costs, exnenses, or causes of action ihat may arise because of ins�allation and maint�:nance of �he improvement or other righl-of�way use hereto applied lor and lurther agrees �o remove same upon notice Irom ihe Approved lor Construction Date Ciry and to replace puhlic property damaged thereby. FINAL INSPECTION Gate - Date Approved as Cons�rucled S'gnature ol APPlicant ':;CRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN everett PUBLIC WORKS DEPARTMENT 180 Df.YS OF DATE PERMIT IS ISSUED AND TIiEREAFTER IS TO � 3200GedarStreet 8E DILIGENTLV PURSUED 70 COMPLETION. THIS PERMIT MAY Bfl Evere�l WA 98201 CANCELLED 9Y TH[CITY UPON ANY STOPPAGE OF WORK ON THIS Phone:259�8810 pROJECi OVER 90 DAYS C:RATION.