3813 RUCKER AVE 2016-01-01 MF Import

�B�Q A��+�-�7_02 Applicetion For PUBLIC WORKS PERMIT Print or Type Only PuElm Workt Parmll • 7� 2� ,� eieo oso� • 3%833 Pu01¢ Worke Fas ` Tolel Fee Lees AOV� Fee PNE s_ Btlmce 0ue = aJ 00 Gb7-.322s�oirc93/ Rathy Decandla 341 Elisabeth kE Monroe WA 98272 794-6489 Owner Meiling Address City Zip rhone Ovner Applicent Meiling Address City Zip Phone Deacribe Propoaed Work EBpL'eeso etand Pro�ect Addreas (if known� Attach four (4) copies uf plans for proposed work • �raw to scale and note the Ioilowing as epplicab�e: • Property Llnea � Outline and dimenaions of all exietinp antl proposed structures on the lot • Existing end proposad utilitles • Cenlertine ol street • Indicete NOAh � Show any proposed greding chenges • Show measurements PERMIT CONDITIONS 1. All cells for Innpection ehall ba metle 24 hre. In edvance • phone 259�9810. 2. All work ehNl bx performed in accordance with thla permit and current City of Everett Design and Construdlon Stenderds end SpecHlcationn. 3. Ca�l Loc�tlon Underpround Service 48 hrn before you diB• TOLL FNEE NUMBER 1-800�4245555. /, �it�+e+� /�e� .i`o �C �tiee.� OWiv �[ r.�.,�. C�'Fe% � �PUBLIC WORKS 7EPARTMENT 3200 Cedar Street '� Everett WA 96201 Phone: 259�P970 ACKNOWLEDGEMENT OF CONDITIONS W F- � � O The undersigned owner/applicanl hereby agrees to hold and save harm• less the City o1 Everett Irom any end all cleims tor damages, costa ezpenses, or causes of action that may urise because ol installetion and mainlenance of ihe improvement or o�her righFcf•way use hereto applied for and further agrees to remove same upon notice Irom the Cily and to replace public property damaged thereby. '� �i i Si�natur oi Appli nt Date WORK UTHORI FD BY THIS PERMIT MUST BE STARTED WITHIN 180 D YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.