3611 RUCKER AVE 2016-01-01 MF Import

Date��f:�l=��% / �nn��cation For PUBLIC WORKS PERMIT Print or Type Only � Applicant Describe Proposed Work Pobbc N'oiws Pnrmn � 1/ �// emg oon� � Puhl¢ Worha Fae g, Totel Fec L�ss APOL Fee Pa1J s� �rianr,o Due a E!"E'� / / _3�0� c��=�.�,E' ,sT. Mailing Address City Zip Phone � E�� Zip Fhone Project Address (il known� — Attach lour (4) copies of plans lor proposed work - Draw to scale nnd note the tollowing as applicable: • Property Lines • CeMerlire of streP� � Outline and �imensions of all existing and • Indicate North proposed structures onthelot • Show any proaosed grading changes • Existing and proposed utilities • Show mcasurements PERMIT CONDITIONS 1. All calls for inspection sha0 be made 24 hrs. in advance - phone 259•881 5. 2. All wor�, shell be perlotmed in accoidance wilh this permit and current City M Ever=lt Design and Conslruction Standards and Specifications. 3. Cail Location Underground Service 42 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. y J'�'T � �� '` .oi ��-- -s� , � � / Date �� FI PEC110N Date ppproved as Construcled everett PUBLIG WORKS DEPARTMENT � 3200 Cedar Street Everett. WA 98201 Phone:259�8815 ACKNOWLEDGEMENT OP CONDITIONS � � �"' � � a The undersigned owner/applicant here6y agrees to hold anG save harm- less the City of Everett irom any and all claims for Aamages, costs, expenses. or causes of action lhat may arise because ol installatlon and main�enance of the improvemenl or olher righFobway use hereto applied for and luriher agrecs to remove same upon notice Irom the Ciry an�o replacepublic properry dam�ged thereUy. i WORK AUTHORIZED BY�f�H15 PERMIT MUST BE STARTED N'ITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO CGMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS PROJECT OV[R 90 DAYS DURATION. '�'