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Date 3/19/86 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pu�l¢ Works Permit + ��—' ��`-� <br />ein9 000i . 86/16268 <br />Pu�Lc Worka Fee <br />Totalfea s <br />less ApOI Fae Peitl $ <br />zn ob <br />Baiance Oue S <br />Lessley Construction 3B49ix 18204 Bothell—Everett Hwy Sott.ell 98012 481-8866 <br />Owner Mailing Address Ci�y Zip Phone <br />same <br />Applicant Mailin9 Address City Zip Fhone <br />Describe Proposed Work Construct new single family home <br />Plan 1096 Lot 30 Willow Creek Glen <br />Project Address (if known) <br />1419 - Slst P2. SW <br />Attach four (4) copies of plans (or proposed work • Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />� Existing and proposed utilities <br />PERMIT 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 shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standarils and Specifications. <br />3. Call Location Underground Service 48 hrs. befcre you dig. TOLL FREE NUMBER 1-800•424^5555. <br />%) /l�� �Co�,Z J' �'-s �aG <br />Approved for Construction Date <br />�.��•�' :3 -/� i� <br />FIGALiF1SPECTI Date <br />Approved as Constructed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone:259•8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />The undersigned owneUapplicant hereby agrees to hold and save harm• <br />less t'�e City of Everett Irom any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of ihe improvemenl or other righ�-of-way use hereio <br />applied for d further ag:ees to remuve same upon notice irom the <br />Ciry and to, eplace public propeity damaged thereby. <br />�---� <br />Si ature of pplicant Date <br />WORK AUTHORIZED OY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PCpMIT IS ISSUED AND THEREAFTEFi IS TO <br />E3E DII.IGENTLY PURSUED TO CCMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOR!C ON THIS <br />�ROJECT OVER 90 DAYS DURATION. <br />