3702 RUCKER AVE 2016-01-01 MF Import

Date_��'7" � Application For PUBLIC WORKS PERMIT Print or Type Only PUEI¢ Worka Permil �'�C� eiao oeo�. . � 1 V PUEpc Worb iee iotel Fee s Lau AOG� Fee PaiE S eal�nce Due nuu�ess Dascribe Proposed Work Prolect Address (if known) Attach four f4) copies of plans for proposed work • Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and proposed structures on the lot � Existing and proposed utilities PERMIT CONDITIONS • Centerline of streel • Indicate Norih • Show any p�oposed grading changes • Show measurements 1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259-BB� 5. 2. All work shall be performed in accordance with ihis permit and current City ol Everetl Design and Consiruction Standarils and Specificetions. 3. Call Location Undergrountl Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5F�5. �.J I�F.PiYlij �!'lT �F'�Jv.,PC'.L� J � /�'� 6 �� Approved lor Construction Date FINAL INSPECTION Date Approved as Construdetl everett PUBLIC WORKS DEPARTMENT � 3200 Cadar Sireet [verett, WA g8201 Phone:259�8815 ACKNOWLEDGEMENT OF CONDITIONS W � � � � O ♦�A V♦ O a The unAersigned owner/applicant hereby agrees to hold and save ha�m- less ihe City ol Everett irom any and all claims lor damages. costs, expenses, or causes ol action that may arise because oi installation and maintenance ol Ihe improvement or other righ�-obway use hereto applied br and turther agrees to remove sam•� �•^on notice from the City and to replace public property tlamaged Ih: Signature of Applicant Date WOFiK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSiIE� AND THEREAFTER IS TO 8E DILIGENTI.Y PURSUED TO COMPLETION. THIS PERMIT MAV BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAVS OURATION.