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�: <br /> 3/19/R6 ,�, _ ���> <br /> Date — �-,������,o���P�.�m�a -- <br /> " umo o�P�.. 86/16262 <br /> Apnlication For — <br /> �, e��l� `A,�1��� nC��pl�� PuplicWorksFeo <br /> v a�v �� ov� TolalFue � <br /> �ess nooi.Fee ca�a 5_ <br /> B�inn�n�ue 5��'1 CCr <br /> Print or Type Only <br /> Lessley Construction 18204 Bothell-Everett Hwy �2 Bothell 98012 981-8£166 <br /> Owner Mailing Address C�ty Lip Phone <br /> Same <br /> Applican� Mailing Addre.,s City 2ip Phone <br /> DesCri6z Proposed Worh Mnctrnct npw ci na]p fami 1 V home . <br /> RaS1C �ZaQ Tnf 19 Wil lnW C'Yt�pk (71Pn <br /> />Dz — :>/—"ivL . S_GL/ � <br /> Project Address(if known) _ � <br /> Attach four(4) copies ol plans lor proposed work- Draw�o scale and note thc following as applicabla: � <br /> • Property Lines • Centerline of sireel � <br /> • Ou�line and dimensions ot all exis�ing and • Indicate North <br /> proposed siructures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed u�ilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> t. All calls for inspection shall be made 24 hrs. in advance- phone 259•88�5. � <br /> 2. All work shall be performed in ar,cordance with�his permit and current City o( Everett Design and Gonstruction <br /> StanUards and Specitications. <br /> 3. Call Location Underyround Service 48 hrs. belore you diy.TOLL FREE NUMBER 1•800•424-5555. � <br /> � <br /> %�C i�'Udr" c` Yisi��.iG !��'�/�='s,J� Cu�:'i;' �'[.i" t,.;cU� � <br /> �r'COit/Sii�'U�i �'C //ciG/,!� Cc-.1'�' tE� .S%f?/�i)/-'�'1� <br /> � 3�5 �' 3��l, L <br /> r- <br /> J� T.L/STALL !�4'e�� - c '„'/ %IT �c:��! „ / r ' � <br /> /�F��I = C � =>i � ,�i/r_'t�/�! <br /> /��cl P�A.c,!S /�E',� C'�j S.—�,�v�.�i� #.��j Op� <br /> �i�, �OL�cF.c' h'N,DO�' %E"G E/"'fj�0i if (/�L�L T �/�.' /J! i G C��'h� i3ea <br /> AP_r�' CcUG C /UEFD Tc'i BF �Fl oC'!Ii�-U �5;=�- J<<},�=c c�,:;�,�. <br /> � P! %%'% %O �ODC/Ji�/r?i c�- r��%iL�iG r ; <br /> � � �ACKNOWLEDGEMENT OF COND!TIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> — — less the City of EvereV from any and all claims tor tlamages. costs, <br /> expenses, r.: �auscs e! 3ction ihal may arise because of insiallation <br /> � � �_ 7 � ^+ and maintenance of Ihe improvement or other right-of-way use hereto <br /> � � ��" "�����,R�N J < s/�� applied for and further agrees to remove same upon notice Irom the <br /> Approved for Consiructioo Date City and to eplace public properry damaged ihereby. <br /> _'���/D�� � �/!� "��_ '�J----� .� ��/�� I� <br /> F L INSPECTION Date <br /> Approved as Constructed i�nature of Applicant Date <br /> PUBLIC W09KS DEPARTMENT V'lORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W'THIN <br /> evereh 180 DAYS OF DATE PEfiM1T IS ISSUEC AND THEREAFTER IS TO <br /> 3200 Cedar 3treet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> � Everett.N!A Q8201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�3915 pROJGCT OVEF 90 DAYS DURATION. <br />