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3/19/R6 �� _ /� � <br /> Date Public Works Perml�a / <br /> � Appi::.�uon For ' � emg.oeo�-* 86/16254 <br /> PUBLIC WORf�S PERMIT Publ¢WarkrFae _ <br /> .a�a�Fe� s _ <br /> Less APpI.Fee Paid w5__ <br /> Priri or Type Only ea�,���o��, s �O�_ <br /> Lesslev Construction 18204 Bothell Rverett Hwy #2 Rothell 98012 481-80f6 <br /> Owner Mailing Address City Zip Phone <br /> Same <br /> Applicant Mailing Address City Zip Phon� <br /> Describe Proposed Work Cnnctrnnf n w circ*le fai�lilV home <br /> Basic 1249 Lot �� Willow Creek Glen <br /> � <br /> — � <br /> Proiect Addre<_s�if known) 5130 - 15th Ave W � <br /> I <br /> At�ach tour(4)copies ol plars ier ��roposed work- Draw�o scale and note�he tollowinc�as applicable: � <br /> • Property Lines • Cen!erline ol street ♦A <br /> • Outline and dimensions of all existing and • InAicate North V� <br /> proposed structures on�h�lot • Sho•,N an��proposed gradin9 changes <br /> • Existing and proposed utilities • Show measuremen�s � <br /> ��': <br /> DO NOT WRIT� BELOW THIS LINE <br /> PERMIT CONDITIONS U <br /> t. All calls tor inspection shall be made 24 hrs. in advance � phone 259•$81 5. � <br /> 2. All work shall be performed in accordance wilh�his permit and curren�City o! Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call �ocation Underground Servicz 48 hr;. before you dig. TQLL FREE NUMBER 1•800-424•5555. � <br /> � <br /> �w <br /> Y/ <br /> O <br /> 1� <br /> n ACKNOWLEDGEMENT OF CONDITIONS I <br /> f.75! <br /> N The undersigr.ed owner/applicant hereby agrees to hold and save harm- <br /> �— less the Ciry of Everett irom any and zll cleims tor damages, cosis, <br /> � ^� � eso�;nses, or causes of action that may arise hecause ot installation <br /> ` / •/z��=��7t?5�'"",- �J L�C>T�!"J and maintenance of ihe ImProvement or o�her ri9hl�of�waY use hereio <br /> applied for and furiher ac�rees to remove same upon notice Irom the <br /> Approved (or Cons ruction ate (;iry and �eplace public properiy damaged thereby. <br /> - / /' � <br /> -�,�:y:.�-�-- i-,�.=-�7 ,v-- 3 ,�'7�� <br />; FIN^. INSPECTIOIJ Dale � <br /> Appreved as Conshucted $ignature ot Applir,ynt Date <br /> I/everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED RY THIS PERMIT IAUST BE STARTED WITHIN <br /> I � 3200 Ced2r Street 180 DAYS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS fG <br /> ' Everetl, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT �dAY BE <br /> I Phone: 259-�815 CANCELLED BY THE CITY UPON ANY STO°PAGE OF WORK ON THIS <br /> \_ P�OJECT OVER 90 DAYS DU�ATION. <br />