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� <br /> I <br /> Date?r/9n� a�oi��wo�ksa�m�i, ci�lt _ /�v L� <br /> A���plica .��� u,. BitlB.oeol.+ $6/16256 _ <br /> PIJSLIC WOI�KS FE'F�MIT Pu�Toa+iFecFee 5 _ <br /> , Less Aypl Foe Pal� $�__�� <br /> �y l �� <br /> Balan_e Due $ iC= �� <br /> Print or Type Only <br /> Lessley Construction, Inc. 18209 Bothell-Everatr rrwv Rn1�ne77 qRm� nrt7�pgg� <br /> Owner Mailing Address Ciry 2ip Phone <br /> Same as above <br /> Applicant Mailinc�Address City Zip Phone <br /> Descrihe Proposed Work Construct sinqle family residence — Hasic Plan 1096 <br /> Lot 9 Willnw f7aak f:lnn <br /> W <br /> Proiect Address�if known) 5131 15th Ave W � <br /> Atfach lour(4) copies o' Ulans tor proposed work- Draw to scale and uote the following as applicable: � <br /> • Property lines • Centerline of streel � <br /> ! Outline and dimensions of all existing and • Intlicate North <br /> proposed structures on the lot • Show any prop�sed grading r,hanges <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRiTE BELOW THI:i LINE <br /> PERMIT CONDITIONS � <br /> 1. All calls foi inspection shall he made 24 hrs. in advanr.e- phone 259-881 5. � <br /> 2. All work shall be perlormed in accordance wilh�his permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underaround Service?8 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. �� <br /> �� <br /> V <br /> �w <br /> V! <br /> � <br /> � <br /> I ,/„�� / ACKNOWLEDGEMENTOFCONDITIONS <br /> yThe undersigned owner/applicant hereby agrtes to hold and save harm- <br /> tess the City ot Everet� from any and all claims for damages, cosis, <br /> " expenses, or causes ot acticn thal may arise because of installation <br /> r � <br /> ���x�,�,�� j�S�,�1 and maintenance of the improvement or other rightobway use hereto <br /> applied tor and further agrees to remove same upon notice from the <br /> Approved for ConsirucC n ate City and o replace public property damaqed ihereby. <br /> � � �<� ��� <br /> FINFCL INSPECTION <br /> Approved as Construcled Signature of Applicant Date <br /> everett PUBLIC WOHI(S DEPPRTMENT WORK AUTHORIZED 6Y THIS PERMIT MUST BE STARTED WITHIN . <br /> 3200 Cedar Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,\VA 98201 BE DILIGENTLY PURSUED TO COMPLE'ION. THIS PERMIT �1AY BE <br /> � Phone: 259-8815 CANCELIED BY THE CITY UPON AtlY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />