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Date.�p,tg�, <br />Application For - <br />PUBLIC WORKS PERMIT <br />Print �x Type Only <br />Pdplic Warlu Permit • �"� - /� 3 <br />eieo.oed.� aa/7a�c7 <br />Puellc Works Fee <br />iolel Fse s <br />Laas Appl Fee Peitl S� <br />BalanceDue $ _ <br />Lesslev Constzuction ,:p�= 1_8204 EWerett-Bothell H�. B�the11 980i2 481-8866 <br />Owner MaiNng Address Cily Zip Phore <br />Same as above <br />Mailing Address <br />Zip Phone <br />G..scribe:�roposedwork �n3la fauiil� racidar�co -T+�s�� p�an »�Q <br />Lot 6 Willow Creek Glen <br />Project Address �if known) <br />Attacn tour (4) copies of p�ans tor proposed work • Draw to scale and note the following as appiicable: <br />11 Property Lines <br />O Outline and dimensione of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilitiea � <br />PERMII' CONDITIONS <br />� Centerline of street <br />� Indicate North <br />� Show any proposed grading changes <br />• Show measurements <br />1. All calls for inspection sha�l be made 24 hrs. in advance • phone 259•8815 <br />2. All work shail be peMormed in accordanc� with this permit and current City of Everett Design and Construction <br />Standards and Spacitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FHEE NUMBER 1•800•424•5555. <br />Approved tor Construc�ion �, � p5te <br />� /� <br />�/-( �X; sr� /-0'7- �% <br />AL IN PECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITfONS <br />W <br />H <br />� <br />The unde•signed owner/applicant hereby agrees to hold and save harm- <br />less the City of Everatt 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 an further agrees to remove same upon notice from the <br />City and to r ce public property damaged thereby. <br />�! <br />Sig ture of App icant Date <br />WJ?K AUTHORIZED BY THIS PERM�T MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT[R 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 />