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fsiLovy <br /> CASH ASSURANCE DEVICE <br /> Section 1 - To be completed by the Project Planner <br /> Instructions: Complete Section I and the Assurance Device License. Attach a copy of <br /> estimate of improvements and fax all documents to the City Clerk's Office. <br /> Construction Site Address 3007 EVERETT AVENUE <br /> Project#, Project Planner REV I 15-005, TERESA WELDON <br /> Name of Depositor BRIAN BODGE <br /> Address 523 61ST ST SE, EVERETT, WA 98203 <br /> Phone 425-879-3437 Email brianbodge@msn.com <br /> Check one: <br /> ❑ Performance(installation)-Not less than 150%of the cost of the improvements or <br /> 300%if in a critical area <br /> El Maintenance-Not less than 10%of estimate of improvements <br /> ❑ Other- <br /> These funds are to be retained for a minimum of 3/0 years/months. The projected <br /> release date is scheduled for January 11, 2019 <br /> Section II - To be completed by the City Clerk's Office <br /> Instructions: Complete the lower portion when deposit is made and route a copy to the <br /> Project Planner and the Depositor. <br /> The amount of$ loo was deposited in the Assurance Deposit <br /> Account(002-239-1006-000)on (date of deposit). <br /> This transaction was completed by x <br /> i <br /> Note for Depositor:It is your responsibility to contact the Project Planner at least one <br /> mo ntln prior to the release elate for inspection. <br /> i <br /> Cash Assurance Device to the City o <br /> f Everett <br /> 2930 Wetmore Avenue, Suite 8-A Rverett,WA 98201 • 425.257.8731 • fax 425.257.8742 • www.cverettwa.org <br /> �3 <br />