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Date3� ��n��:wo,�sFo,m�. ���r• ' ��l- <br /> Applir.alioc Fo� Bmq.Deo� e_$6�76255 <br /> �'UBLIC W�R�S RE�itUtiT PubTolalFteF�G 5 <br /> Less Appl.Fec Fe1c S <br /> ��- c-r <br /> Prin; or lype Only � o��,���• o:� s - <br /> Lessley Construction, Inc. 18209 Aothell Everett Hwy Bothell 98012 481-6866 <br /> 7wner Mailing Address Ciry :'ip Phonc <br /> Same as above <br /> Applicant MaiLn�Address City Zip Phone I <br /> DesGqbeProposedWork C[�nctrnnt sinnl f 'lv 'A a 'r cl 1749 Tnt A Willry. (`trF_.nk rlen <br /> - W <br /> Prolect Address(if known) 5125 lSth Ave. W. _ LI <br /> r <br /> Adach ir,ur(4)copies of plans for proposed work- Druw to scale and note 'he lollowinn as applicable: � <br /> �� f�rcoerty Lines Y Cen�erline of sheet ,y.��y <br /> Y �)utline 3nd o m=nsionc of all existing and • Indicate tJorth �, <br /> uropo����d s.!r�i-f���ns on ihe lot • Show any propoead gradiny changes <br /> a'� Lxisti g ., i � �, ,sed utilities v Show measurements � <br /> W���lillf� � <br /> DO MOT WRITE BELOW THIS LINE � <br /> FERMIT CONDITIONS <br /> t �li calls lor inspection siiali be mada 24 hrs. in advance- phone 259-8815. � <br /> :. FII work shall be pertormed in accordance wit'��nis permit and current City of Everett De�iyn and Gonstruction <br /> Standards and Specihw�ions. <br /> 3. Ga�f Loca!ion Underg�ound Se�vice 43 hrs. before yo� Jig.TOLL FREE NUMBEt� 1•80C�•424•5555. � <br /> Y, ,lJ.G'l4�r� LC.!.=J' ��`'' Tf/iS LC'% G(.�r�`� l iG��%i"G G�L� o <br /> f>f>,�,-Lf/ ��/✓ GG; �7' Ex,s,—,NG Cv.�'B c'vT ,s <br /> T:> .�E �'E�nc<�'.D �?�✓�� ,���i F�cE",v C�t/.�-ii Fv�L � <br /> %� iC-h'i C'U.�.� f�E�' c.'/Tf/ S%y�/Dfr',�'/� �,�p� � �<'i� /A <br /> ' V♦ <br /> � �.Ir�J TXic�FuJ�9/ /� i= /;<.= 1,� ";; �, �..�, ��;� O <br /> � �,;?. :''./'f';'� `, -`�� �- � <br /> ACKNOWLEDGEM1tEN i OF CONDITIONS <br /> The undersigned ownedapplicant hereby aqrees to hold and save harm- <br /> — - -� ��-- less the CiPi of Everel� Irom any and all claims lor damages. costs, <br /> � � � / expense�, o causes of action lhat may arise because .i installa�ion <br /> �� � � / �� �y/ . �� � � and mai�rie, ance of the improvemen� or other riqhl-ol�w3y use hereto <br /> ��v— �� ����'""' •� " � - ��"� applied 'r anJ fur��ier agrees to remove same upon notice from tlie <br /> Approved lor Cons ruction i' Date�� �itY and i.��cplace public property damaged �.hereby. <br /> —y?��%3 -/G -.�7 � i ���.,��- �/�� � <br /> %� AL INSFEC ION Date %,G_ <br /> Approved as Consiructetl .�ignature uf�i pplicard � Date <br /> everett PUOLIC WORKS��EPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Stre�•t 18(i DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 BE OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPHG[OF WORK ON THIS <br /> PROJECT OVER 90 D.4YS DURATION. <br />