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� .� <br />� � 3/19/86 <br />{l8 <br />/ <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type �nly <br />PuElic Works Permit � �L <br />eiao.oeo�.+ 86/16261 <br />PuElit Won a Fae <br />Tolal Fe•� s <br />Leaa Apo� Fae Paitl S__ <br />Balance Uue t �L� C� <br />_ Lesaley Construction 18204 Bothell-Everett Hwy R2 Bothell 98012 431-8866 <br />Owner Mailing Address City 2ip Phone <br />Same <br />Applicant <br />Mailing Address <br />Describe Proposed Work �nstruct new sinale fdIDily residence <br />Basic 1249 Lot 26 Willow Creek Glen <br />ProjectAddress(itknown) 7573 — S� p1 cW <br />Zip phone <br />Attach four (4) copies of plans lor 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 propo��ed utilities <br />• Centerline of street <br />� Indicate North <br />• S:�ow any proposed grading chany=s <br />• Show measurements <br />PEAMIT CONDITIONS <br />1. All calls for inspection shall be m�de 24 hrs. in advance • phone 259•8815. <br />2. All work shall be pertormed in accordance witY this permit and current City of Everett Oesign 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 />� � ��� J 8G <br />Approved f r Construction Date <br />�i��� 3 -�7-6� <br />FI L INSPECTION 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 CONDITIONS <br />W <br />H <br />� <br />The undersigned owner/applirant 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 properry damaged fhereby. <br />� ' �l i2!/�J <br />Si atII(e o �Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHI�� <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 />