4201 RUCKER AVE EVERETT CLINIC 2018-01-02 MF Import

Date y'7 yIf 1 \ I IS Elk Web PNm" . r= Application For ass oba. • Q/ PUBLIC WORKS PERMIT Print or Type Only Describe Proposed Work Project Address (if known) Public WMIS FM Total FN Labe AbM FM P W • Mona Dw -1L-0, (L)A`�gl1l Zip Phone Phone Zip Attach four (4) copies of plans for proposed work - Draw to scale and note the followi /J • Property Lines • Centerll ry r • Outline and dimensions of all existing and • Indicatl J proposed structures on the lot • Show a1 ' —a ,s, • Existing and proposed utilities • Show It ap( Pla n DO NOT WRITE BELOW THIS4 1!►'1 %00 PERMIT CONDITIONS 1. All calls for Inspection shell be made 24 hrs, in advance - phone 21594 r1� 2. All work shall be performed in accordance with this permit and current It (/V"' Standards and Specifications. 12 3. Call Location Underground Service 48 hoe. before you dig. TOLL FREE ' T/1 Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT Everett Cedar Street Evere Ett. WA 98201 Phone: 259-8810 ACKNOWLEDGEMENT OF CONDITIONS W z 0 0 an The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, expenses. or causes of action that may arise because of installation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upor. notice frorn the City and to replace public property damaged thereby. Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W11HIN 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 90 DAYS DURATION.