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io/zz/as <br />Date • � a�oi�owo�ksae,m�i. <br />Acplication For oieq oco�. • 85/15G14 <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />First Covenant Church 4502 Rucker <br />Puol¢ Works Fee <br />TotalFee S <br />Less RppL Fee Paid S <br />BalanroDue � <br />Everett 98203 252-9191 <br />Owner Mailing Address Ciiy Zip Phone <br />Same <br />Mail�ng Address <br />City <br />Describe Proposed Work Enclosure o£ Couit—Adding three walls <br />Project Address (it known) <br />Rucker <br />Attach lour (4) copies ol plans lor proposed work - Oraw to scale and nole the following as applicable: <br />• Property Lines • Centerline ol street <br />• Outline and dimensions ot all ezisting and • Indica�e Norih <br />proposed slruct�res on the lot • Show any proposed grading changes <br />• Existing and proposed ulilities • Show measurements <br />PERMIT CON�ITIONS <br />Phone <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work shall be pertormed in accordance wilh ihis permit and current City of Everett Design and Consiruction <br />Standards and Specilicalions <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />/v� PUB2/G //L%J.E'.CS �E.ein// .P�L�rJi.PE�D <br />Approved lor Construdion <br />FINAL INSPEC?ION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar S�reel <br />Everett. WA 98201 <br />Phone: 259-8815 <br />� y�� /D/S/f�s <br />Date <br />ACKNOWLEDGEMENT OF CUNDI7�ONS <br />W <br />� <br />� <br />Thr �ndersigned owner/applicant hereby agrees to hold and save harm- <br />Ivss ihe City ol EvereU Irom any and all claims lor damages, cosls, <br />expenses, or causes ot action Ihat may arise because ol installation <br />and maiNenance ol the improvement or other righFof-way use hereto <br />applied for and lurther ayrees to remove same upon notice Irom the <br />City and to replace public property damaged ihereby. <br />Signature of Applicant Date <br />N'OfiK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO <br />B'_ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />ChNCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEH 90 DAYS DURATION. <br />