4312 RUCKER AVE BOYS AND GIRLS CLUB OF SNO CO 2018-01-02 MF Import

Application For PUBLIC WORKS PERMIT TYPE OR PRINT ONLY PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 96201 259-8810 Date '7a o24e Public Works Permit N _ 96127 z Building Permit N -o Public Works Fee $ n Zc �— SS-2 Describe Proposed Work 2 Zip I Phone Zip PROJECT ADDRESS (if known) ^T'TGU F%vV r7 'Lc—� f`�V Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: "Property Lines `Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities *Centerline of street •Indicate North "Show any proposed grading chants •Show measurements PERMIT CONDITIONS: 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. 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. rec, Gee �ont�4r fJiri�? ld��!->7e�c�/c+h —� 2 4 6 Approv d.�J rCon/u tf Date / FINAL INSPECTIO Date Approved as Constructed 7- 2s- s6 09/06/96 9:32AM I N00052436 BLOC 11100.00 SRC RG $4.50 (lM62rt OTHER $M.00 CHECY, $44.50 W 0 z 0 vI 0 0:kK ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless 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 remov*skne upon notice from the City and to replace public property of Applicant WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED 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 90 DAYS DURATION.