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��. APPlication For � � — `� —'---- <br />� Pl1BLIC WC�RKS PERMIT Date 2-14-96 <br />� /' <br />PUBLIC WORKS DEPARTMFNT Public Works Permit k _I�O%� __ <br />3200 Cedar Sireet <br />Everen, WA 98201 359-8310 <br />Building Permit q_ 50884 <br />n�EGRPRINTONLY Tfl POSTING SEP 19199�ublicWorksFeeS_/�fA'��.5__C�_ <br />Henrickson Hugh PO Box 5641 Evei•ett WA 98206 658-8917 <br />Owner Mailing Address City Zip Phone <br />Owner <br />Applicant Mailing Address City <br />Describe Proposed Work new pole build <br />PROJECT ADDRESS (if known) <br />Zip Phone <br />']'ipi;°� SZ�<±^u n,�����uip.:,-, <br />q0�0:,0�E4 <br />----�„ . ._� <br />:4'CHRL .�.5� <br />F O . <br />�. DS� �ViJY $^Q.00 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: �_,��!F('l; $�5�j, �i�R <br />'Property Lines •Outline and dimensions of all existing and proposed simdures on the lot •Existing and proposed utilities <br />•Centedine of sireet •Indicate North •Show any pmposed grading changes •Show measuremenls <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 a�cordance with this permit and current (:ity of Everett Design and <br />Construction Standards and Specificat�ons. <br />3. Call Lecation Underground Service 48 hrs. before you d�g. TC�LL FREE NU116ER 1-000-424-5555. <br />a� � L' '� S�et�s G�R,� o+��' a�j -�fl�•et <br />, <br />,5, l�h s'{ttG/ /?�ilc �on S�i'r�c fi'�i �-+�i'�ce, <br />�o, �i�Si�'I �o•a frc! sGta�/ � �i1 S��G� c�-��'h,z <br />�,N cGt; �i o�%.c �6 !z •l,�J�� /.ys��c.�vr: <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplican� hereby agrees to hold and save harmless <br />ihe Ci'•� nt Everett Irom any and all claims for damages, costs, ezpenses, or <br />causes . ction that may arise because of installation and maintenance of <br />Ihe improvement or oth=r right-nf-way use hereto applied for and turther ar�rees <br />to remove same upon notice trom ihe City and io replace oublic property <br />damaged ihereby. <br />.yy - Y/I`�� <br />Signature of R�plicaM Date <br />INORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 190 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DIIIGENTLV PURSUED TO <br />C0�IPLETION. THIS PERM1IIT MAY BF �qNCELLED 6Y THE CIN UPON ANY STOPPF�GE OF WORIC ON THIS PROJECT OVER 90 DAYS DUflATION. <br />