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" ,ecaau, For <br />PUBLIC W JRKS PERMIT <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Proposed Work,_ <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />32nO Cedar Street <br />Everett, WA 98201 259-8810 <br />Plan Check NO: B 59800 <br />Applicat.Date: 08/11199 <br />Jot, Addrs: 9702 19TH AVE BE <br />Owner: ENGLUND ERIC <br />Tenant: US WEST WIRELESS <br />Proposed Use: COMMUNICATIONS <br />Desc. of Work: <br />INSTALL EQUIPMENT SLF.B & MOUNT <br />EXISTING PUD POLE <br />Date <br />Public Waka Permit A <br />BuNrHnS Permits_ <br />Publi. Wbrlo Fee $ <br />SEPA <br />ANTENNAS OP Phone <br />OFFICE SET JOB SET_ <br />APPRVD FOR PERMIT: DATE_/_-/_ By___ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the fo!bwing if applicable: <br />'Prooerty Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing ar,l proposed utilities <br />'Centerline of street •Indicate North 'Show any proposed grading changes 'Show measurements <br />PERMIT CONDITIONS: <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 with 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 />"UQLIC won,($ Fp <br />►ti0i 6UUIR6w J <br />d Y__ <br />NATF--� G <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />r� <br />M <br />0 <br />z <br />0 <br />Ian <br />0 <br />a <br />ACKNOWLEDGEMENT OFCONDITIONS <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, expenssa, or <br />causes of action that may arise became of Irotapstlon and malydenarkx of <br />the hrprovenent or other right-of-way use teaato applied for and further - ii <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DEXlil TLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION, <br />