4312 RUCKER AVE 2018-01-02 MF Import

oBtt3 - 3 r =86 Application For PUBLIC WORKS PERMIT Print or Type Only 1- Kk7 Owner Public Works Permit • �"' —`� /� Bldg Dept Public Works Fee S Total Fee Less APpt Fee Paid s aalance Due fl.Q k-+f_•r.�r Applicant Mailing Address City Zip phone Describe Proposed Wor (J A- W Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Properly Lines • Centerline of street • 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 M DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS r O 1. All calls for inspection shall be made 24'firs. in advance - phone 259.881 5. 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. S �i/c7T/F sh% f vo'C iC Ltiov-' f- ACIV lUf/F2% co Approved lot Construction / // Date FINTL177SPECT15N Data Approved as Constructed i PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 "A L- ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, coste, expenses, or causes of action that may arise because of installation and maintenance lot the impr me Pt or other right-of-way use hereto lie a d fi ther �gre to remove same upon notice from the Cit d r p- bli pr prty damaged thereby. WORK AUTHORIZED BY THIS PERMIT MUST BE S-ARTED WITHIN 180 DAYS 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 30 DAYS DURATION.