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Date 3 19 86 <br />Application For - <br />PUBLIC WORKS F`ERMii <br />Print or Type Only <br />Pu�l¢ WorksPermll+ ��� —/� O <br />eiop oeo� • 86/16263 <br />Puoiic worxs Fae <br />iu�ui Fee S <br />Less A4��� Foe Paitl S <br />2 d "-° <br />Balenca Oun S __ <br />Lesslev Construction 18204 Bothell–Ewerett Hwy #2 Bothell 98012 481-8866 <br />Owner Mailing Address City Zip Phone <br />Same <br />ppplicant Mailing Address C:ity Zip Phone <br />Describe Proposed Work �nstruct new single family home __ <br />Basic 1096 Int 19 Willow Creek Glen <br />Project Address (if known) <br />Attach lour (4? copies of plans for proposed work • Draw to scale and note the following as applicable: <br />� <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 s��eet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremeiits <br />1. All calls for inspection shall be made ?4 hrs. in adv2nce - phone 259•831 5. <br />2. All work shall be performed in accordance wi: h this permit and current City ot Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 46 hrs before yo�; dig. 70LL FREE NUMBER 1-800•424•5555. <br />J, <br />Approved <br />FIRXL INSPECTION <br />Approvetl as Constructed <br />everett FUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />EveretL WA 98201 <br />Phone:259•8815 <br />Date <br />ACKNOWLEDGEMENT OF CONDITiONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />The und�rsigned owner/applican� hereby agrees to liold and save harm- <br />less ihe City ot Everett Irom any and ail claims for dama�e.:. costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other rinhDcFway use hereto <br />appGed lor and furiher ac�rees to remove same upon nntice from ihe <br />City and o replace pub!ic property damaged thereby. <br />_ / <br />Signatu ot Applicant Date <br />WORK AUTHORIZED BY THI� PERMIT MUST 8[ STARTED WITHIN <br />180 DAYS OF DATE PEPMIT �S ISSUED AND THERFAFTeR IS TO <br />BE DILIGENTLY PURSUED TO C.'�MPLETION. THIS P�RMIT MAY EE <br />CANCELLED BY THE CITY UPON :.NY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIO�. <br />