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olicatlon For <br />PUBLIC llwORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-881 o <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />Datt <br />Public Works Permit If <br />Building Permit k <br />Public Works Fee $ <br />Plan Check Nc: B 51765 <br />Applicat.Date: 05/17/96 SEPA Phone <br />J ob Address: 95 6 19TH AVE SE <br />Owner: HERSHIP SALLY <br />Tenant: AT&T WIRELESS SERVICES <br />Proposed 'Jae: ANTENNA <br />Desc. of Work: Phone <br />INSTALLATION OF CELLULAR EQUPIHENT AND <br />ANTENNAS <br />OFFICE SET JOB SET W <br />APPROVED FOR PERMIT: DATE_/_/__ BY LU <br />NNW <br />co <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />'Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />'Centerline of street 'Indicate North •Show any proposed grading changes •Show measurements <br />------------ <br />PERMIT CONDITIONS: "v r `vr1I t t btLUW THIS LINE <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance w:th this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />Approved 'for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed Date <br />>JBLIC WORKS PERM" <br />NOV SEOUIRE4 <br />►ATE- <br />Ca <br />0 <br />z <br />O <br />0 <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSU DDate <br />TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />