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Date a�oi��worw.a.rmn. <br /> Applicalion FOr b;ep Deot.• <br /> PUBLIC WORKS PERMIT PueTotalFeeFee s <br /> �vu eoo�Fae vam S <br /> Print or Type Only nlan Check No: C 43387 SEPA B�bnceDue S <br /> �plicat.Date: O1/27/94 <br /> Job Addrs: 1707 RUCKER AVE <br /> Owner: REATY PAT <br /> Tenant: <br /> Propoeed Uae: SINGLE FAMILY RESIDENCE <br /> Ow�er Deac. of Work: :ip Phone <br /> 2ND STORY ADDN . <br /> OFFICE SET JOP SET <br /> 4policant .iP Phone <br /> APPRVD FOR PERMIT: DATE_/_/_ BY <br /> Describe Proposed Work _ <br /> W <br /> Project Address 1i1 known) � <br /> Attach tour(4)copies of plans for proposed work- Drew to scale and note the lollowing as applicable; � <br /> � Property Lines • Centerline of street � <br /> • Outline and dimensions ot all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Eaisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All cells for inspection shal�ba mede 24 hre.in advance•phone 259•8810. � <br /> 2.All work shalt be periormed in accordance with this permit and current City of Everett Design end Construction <br /> Standards end Specificationa. <br /> 3.Call Location Underground Service 48 hrs.before you di�.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> PUBLIC WOpKS PERMIT � <br /> NOT REOUIRED � <br /> eY � O <br /> OATE / 27 y�c � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneqapplicant hereby agrees to hold and save harm• <br /> �ess the City ol Everett irom any and all claims for damages, costs. <br /> expenses. or causes et action that may arise because ot installation <br /> and maintenance ol the improvement or other righPol-way use hereto <br /> applied lor and further agrees to remove same upon notice irom the <br /> Approved for Construclion Date Ciry and to replace public property damaged thereby. <br /> FINAI INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> �A�� FUBIIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CederStreet 1H0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 98201 BE DILIGENTLY PURSUED TO C0�4PLETION. THIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />