3531 RUCKER AVE 2018-01-02 MF Import

Date" ys Application For PUBLIC WORKS PERMIT Print or Type Only Address City Applicant Mailing Address City Describe Proposed Work /<A= l�/Sg� �%�`1 Project Address (if known) Public Works Permit • 1�� 3 Bid, pert • __ —._ Pubbc Works Fee = Total Fee Lee. Appr Fee Perri i ael.ncoDue Attach four (4) copies of pans for proposed work , Draw to scale and note the following as applicable: • Property Lines Centerline of street • Outline and dimensions of all existing and • Indicate North • Show any proposed grading changes proposed structures on the lot • Show measurements • Existing and proposed utilities PERMIT CONDITIONS I. All calls for inspection shall be made 24 hrs in advance - phone 259.8815. L All work shall be performed in accordance with this permit and current Cit.,of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424-5555. y T fr'E l'��i✓.s,-.� vc: En i��' f G .a.,/S .C2'.r/ 7 Approved for Construction- - - - FINAL INSPECTION Date Approved as Constructed E tt PUBLIC WORKS DEPARTMENT Ever tt, WA Street Everett. WA 98201 Phone: 259-8815 ACKNOWLEDGEMENT OF CONDITIOf S W 0 z 0 0 a The undersigned owner/applicant hereby agrees to ho'd and save harm- less the City of Everett from any ano all claims for r'amages. costs, expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of-way use hereto applied tot and further agrees to remove same upon notice from the City and to replace public property damaged thereby. Sig ature of Applican rDate WORK AUTHORIZED DATEE PERMIT ISPERMIT ISSUED AND THEREAFTER IS TWITHIN 180DAYS OF O BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 1 iIS PROJECT OVER 90 DAYS DURATION.