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� �1 <br /> Date Pu�lie Wo�ks Pe�mll• <br /> Application For eiee-oeni.• <br /> PUBLIC WORKS PERMIT PUbTaIalFenFee $ . <br /> Less Ao�l Fee PaiO $ <br /> Print or Type Oniy Balance Due s <br /> Plan Check No: B 44366 SEPA <br /> Applicat.Date: OS/12/94 <br /> Job Address: 8818 lOTH DR SE <br /> Owner Owner: NORDSTROM DAN & VIRGINIA Phone <br /> Tenant: <br /> � Proposed Use: SINGLE FAMILY RESIDENC'E <br /> Desc. of Work: <br /> Applicant ADDITION Phone <br /> OFFICE SET JOB SET <br /> Descri6e Proposed Work — — <br /> AP^ROVED FOR PERMIT: DATE_/_/_ BY_ <br /> W <br /> Projecl Address(if known) � <br /> Atlach lour(4) copies ef {;tans lor proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Cenlerline of street ♦^ <br /> • Outline and dimensions of all existing and • Indicate North �� <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utiiities • Show measuremenis � <br /> � DO NOT WRITE BELOW THIS LINE O <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 /> Slandards and Specificalions. <br /> 3.Call Location Underground Service 40 hrs.before you dig.TOLL FREE NUP.IBER 1-800•424-5555. � <br /> 0 <br /> PUBLIC WORKS PERMIT <br /> NOT F�EQUIRED � <br /> BV -''J�� � I_ <br /> DATE �G V� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applican�hereby a�rees to hold and save harm• <br /> less the Cily ol Everett Irom any and all claims tor damages, costs, <br /> expenses, or causes of action that may arise because of inslallation <br /> and maintenance of the improvement or other right-ol-way use hereto <br /> applied for and furlher agrees to remove same upon notice Irom the <br /> Approved lor Construction Date City and to replace p�blic property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Signature ol Applicant Dale <br /> PUE1LIClNORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMITIS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPI_ETION. THIS PERMIT MAY BE <br /> `� tT�' Everelt WA 90201 I CANCELLfO B'f THE CITY UPON ANY STOPPAGE OF WOqli ON THIS <br /> Phnnr� ?q9�f1Rif1 . .. . � �.,� ,. . ,...,.. �.�,... ,�.,,i <br /> � <br />