3805 RUCKER AVE 2018-01-02 MF Import

Date 2-1-Q5 Application For PUBLIC WORKS Print e, Type Only r Gordon Anderson 3805 Rucker TO"- POSTING of CA PERNUT Q Ifs l'•1 t` rT V wr 2"Mr: Works permit. —5�;/M,3 Bldg Dept • AAR87 P.Ohl Works Fee Total Fee $ Less APPL Fee Paid $ Balance Dee $ /.59sU M1 n-21114 cz � F' rnone O U \ W Owner Applicant Describe Proposed Work addn to Taco Time Project Address (if known) Gip Phone Attach four (4) copies of plans for propose6 work - Draw to scale and note the following as applicable: • Property Lines • Centerline of sir eel • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for Inspection shell be made 24 hrs. in advance - phone 259.8810. 2. All work shall be performed in accordance with this permit and current City 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. 51 GI/O c E r BG oexle PEiz �PP/�vdc0 Approved for Costruclion Date _ _ 2 2 -?l— FINAL- P ION��' Date Approved as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259-8810 ACKNOWLEDGEMENT OF CONDITIONS W IM O M) z O O a The undersigned owner/applicant hereby agrees to hold and save harm. less the City of Everett from any and all claims for damages. 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 f r and further agrees to remove same upon notice from the City a�7o replace public properly damages' thereby. Sifnatme of Applicant '- - —te WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLI BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT . :R 90 DAYS DURATION.