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2/23/94• <br />Date <br />y <br />Application For TO POSTING <br />`1 <br />N U rJ <br />werksPermn4 <br />r�yU <br />-°'°o. oeor• <br />PUBLIC <br />WORKSERIUIIT <br />Public works Fea <br />L, <br />Total Fee S <br />ccl <br />r' <br />Less Aoot Fae Paid S <br />Print or Type Only <br />53 $ $ <br />$ <br />Balance the <br />o o c� n <br />N N M <br />o <br />H Man4815 135th <br />M <br />Pl NE Plarysvba�- <br />llea 98270 65g'2b"1 <br />-a jcc yc//83/ /J <br />Ownerer <br />Mailing AddP s Fprp���r <br />y <br />Zip <br />-;?22x/o/283 <br />Phone <br />Dick Anderson 252-0136 S m 'q— <br />Applicant <br />Mailing Address City <br />Zlp <br />Phone <br />Describa Proposed Work <br />New 4 — Plex <br />Project Address (if known) 3920 Rucker Ave <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />Proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance -Phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />�J�C 2 L�f: Li��.S Ta 1ZQ2 %c:np <br />Approved for Const/uction Date <br />FINALF NAL INSPECTION <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Nit T" <br />Everett, WA 98201 <br />Phone: 259.8810 <br />eI <br />ACKNOWLEDGEMENT OF CONDITIONS <br />UJ <br />O <br />Lon <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />S(gn ture of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MaY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />