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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only Plan Check No: B 48853 SEPA <br />Applicat.Date: 07/03/95 <br />Job Address: 49 5 RUCKER AVE <br />Owner: OLSON HARRY <br />Tenant: <br />Proposed Use: SFR/GARAGE <br />Owner Deac. of Work: <br />NEW GARAGE 6 CARPORT <br />Applicant <br />Describe Proposed Work _ <br />Project Address (if known) <br />M <br />OFFICE SET JOB SET <br />.ip <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as - nolicable <br />Public, WOG$ Permit <br />Bldg. Darts <br />Public Works Fee S <br />Total Fee <br />Less APCt Fee Paid $ <br />Balance Due $ <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indic:;,; North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />'UBifO WORKS PERitill <br />Nor. REOUtREn <br />3 y.__ <br />'2ATE_ <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />CLPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />N <br />ca <br />O <br />n <br />z <br />O <br />r� <br />CI <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant uate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />