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Date �19��6 ` Pub6c Works Permii • �T l� �J� S <br />— - BIOg. Dept. e 86/16264 _ <br />Application For <br />PUBLIC WORK� PERM�i <br />Print or Type Only <br />PubtitWorksFee s <br />Tolal Feo <br />LessAOP�-Fc^Faid S <br />Baiance Oue $ ��, � <br />Lessley [7onstruction 18204 Bothell-Everttt Hwy #2 Bothell 98012 481-8866 <br />p,N�e� Mai{ing Address City Zip Phone <br />Same <br />Describe Proposed Work <br />Project Address �if known) <br />Mailing Address <br />Construct new <br />home <br />Zip Phone <br />Basic 1096 Single Family Residence Lo�-� Zp_ <br />Atlar,h fow� (4) copies of plans for proposed work • Draw to scale and note ti.e following as applicable: <br />• Property Lines • Centerline of stre�l <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot �� Show a�y proposed grading changis <br />• Existing and proposed utilities •:)how measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall he made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Undergro�nC Service 48 hrs. before •/ou dig. TOLL FREE NUMBER 1-800-424-5555. <br />7- �E'f'I�CE Fx; sTi•t/� CG�.eB cvT l�JiTN �GG h'•-iG-�►' <br />��,z� ��� �,�Ty ST�,��A,�� �.���5 � #.�o� , <br />S _/'ON��T.E'Gl i /(J�c�J <br />C/Y� �Si�•uD6',�0 <br />D.P/UfGcJFi' <% <br />� .�G� 7, � <br />�.{�' {J/C' t`� � G S �'(i <br />Appro�•ed for Construction Date <br />3 /� d7 <br />FINAL . PEC710 Date <br />ApproveG as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3::00 Cedar Streel <br />Everett. WA 98201 <br />Phone:259�8815 <br />cv�- ,��F,� <br />ACKNOWLEDGEMCNT OF CONDITIONS <br />W <br />H <br />� <br />� <br />Z' <br />O; <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />ezpenses, or causes of action that may arise because of installation <br />and mainlenance ol ihe improvement or other righ�•of-way use hereto <br />applied for agct further agrees to remove same upon nolice from ihe <br />City and to r place public property damaged ihereby. <br />/� t <br />Si ature of Applica,.:� Date <br />WORK AUTHORIZEi) G'/ THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DAS� PEHMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED 1'O COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THF CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 9� DAYS DURATION. <br />