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Date�129�fliz ' P����,�wo,k;P.,m„> �'�— <br /> -_ C -- <br /> Application For aia�.oea�.��16258 <br /> Rf1�L,yC WORKS P�RIVIIT Publi[W4fk5F(d 5 --- <br /> Tolal feo <br /> lessf.ppl FeePaid S <br /> /IG7 <br /> Print or Type Only �,����f�u� S ,�� ` <br /> Lessiev Construction Inc. 16204 Everett-aothall rt�y aothali qRn�9 481-R066 ____ <br /> Owner Mai{ing Address City Zip Phonr <br /> Same a:; above <br /> pplicant Mailing Address City Zip Phone <br /> Desciibe Prcposed Work Constriict sinale familv= Basic Plan 1096 <br /> Lot 11 Willow Creek Glen <br /> // —`,-- - �iii <br /> Projed Address lif known) ��17' "' / �t��L�s��• �-��i � <br /> Atlach tour(4) cupies of plans�or proposed work� Draw to scale and nole the lollowing as apWicable: � <br /> • Proper�y Lines s C;enterline of street /� <br /> • Outlirie and dimensions of all existi�g and • Indicate Norih V� <br /> proposed structures on the lot • Show any proposed gradin5 changes <br /> � • Exi,ting and proposed utilities • Show measurement:, � <br />' ������ DO NOT WRITF BELOW THIS LINE ��T`� r <br /> PERMIT CONDI'IONS Q <br /> 1. All calls I..; ,-.;pection shall be made 2a hrs. in advance- phone 259-881 5. � <br /> 2. All work s',::' be periormed in accordance wilh this permit and currenl City o!everett De:i4n and Constructien <br /> Standards and Sprcifications. <br /> 3. Gall Location Underground Service 4R hrs. bebre you tlig.TOLL FREE NUMBER 1•800-4'L4•5555. � <br /> T �E��;��G'E' �xi�:i�,'tr 1�.?ib'C-:�Jf.'/ �^ci.E!3 G�i/% �iiJi� � <br /> �ECo.z�.Si�E'!.'CT" �CC /�FiGh�T Cv,�'b' f'F•� STiqivOF<i� <br /> s� ._3nS St- �o�' . � <br /> 5, 1/✓SiFJ�L if,E�J „�j,�id�;-�9� .1J1" LOC'fi%i���,/ S�/��<.c�i,;� • � <br /> J ' O <br /> D�' f>%,.✓J fc;c' C�i% <<i��;'�'.%:, .; .-` � . , <br /> y _ <br /> a <br /> ACKNOWLEDUHiAf KT �F COtJCff'ONS <br /> The undersignetl ownedapplicant hereby ag�ees to hold and save hann- <br />— �"-�--�-�--- less Ihe City of Everett irom any and all c�auns for damac�es costs. <br /> ,�_ ���� , �., expenses, or causes of action that may zrise because of installation <br /> � > �� - and mair;enance ol the improvemenl or c ner right-of-Kay use hereto <br /> �;.K/,h'." _�.', T <br /> appli�:d lor and further a9rees to remove same upon notice Irom the <br />� Approved�tion � ate � Ciry �:nd to repla:,e public propc�rh� tlamaged ihereby. <br /> � / ^J � <br /> 4 �//'/L+ <br /> FINAL EC ON ate <br /> A oved as Cons�rucled Signature oi ApUlicant Date <br /> everett PUBUC WORKS DEPARTMENT W�RK AUTHORIZED BY THIS PERtdIT MUST BE STARTED WITHIN <br /> � 3200�edarSireet 180 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-9815 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />