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D3tB 3/19/86 <br />Application For � <br />PUBLIC WORKS PERMIT <br />Print or Tyoe Only <br />Popl¢WorksPermit+ ��� —/�� <br />emA oea�.• _ 86/16267 <br />Pu�bcWorksFae s <br />Total Fae <br />Less Appl Fee PaiU <br />6aianceDue S 2��✓ <br />Lesaley Construction 18204 Bothe!.1-EVerett Hwy #2 S Bothell 98012 <br />Owner Mailing Address City Zip <br />481-8866 <br />Phone <br />Same <br />Applicant Mailing Address City 2ip Phone <br />Describe Proposed Work Constxuct new sinale fami�V � hame <br />BaGic sG 1096 i�+t 27 Nillow GYeek Glen <br />Project Address (if known) <br />1507 — 51st P1 SW <br />Attech four (4) copies of plans for proposed work - Draw to scale and note the followinq 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 ot street <br />• Indicate North <br />� £how any proposed grading changes <br />• Show measuremEnts <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259-8815. <br />2. All work shall bf� performed in accordance with this permit and current Ciry of Everett Design and Construclion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />��.� � -�2. 3 z.s < � <br />Approved for Cnnstructio a�e <br />--:�%�4� '�' ���J <br />FI INSPECTION Date <br />Approved as Constructed <br />everete PUBLIC W�iFiKS DEPARTMENT <br />� 3200 Cetlar Street <br />Everell. WA 98201 <br />Phone:259-8875 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applica�t hereby agrees to hold and save harm• <br />less the Ciry ol Everetl from any and all claims for damages, costs, <br />expenses. or causes of acl�on that may arise because of installation <br />and maintenance of the improvement or other right-of�way use hereto <br />applied for and Furiher agrees to remove same upon noiice trom ihe <br />City an to replace public property damaged thereby. <br />- �-� �/,�-7��" <br />ignalure GPlicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIN <br />180 DAYS OF DATE PERMIl 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 WOP.K ON THIS.� <br />PRO.IECT OVER 90 DAYS DUh7ATION. <br />