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PUBLIC WO�tKS P�RMIi <br />� Ciry of Everett F'uuhc Works f)epaiunuN <br />;-i�,�. r..cs�-, :5200�Coti3r 56GCal <br />� ;"`'�„ I_vcrelt. WA 9F17.01 <br />(n25) 257�Afi f 0 <br />OWNER NAME AND ADDRESS: <br />CITY OF EVERETT <br />3200 CI:UAR ST <br />EVERL7T WA 98201 <br />PHONE: <br />'AX PARCEL ID f! <br />DESCRIP110N OF PROPOStD WORK: <br />REPLACE POLES <br />l�nta 5l`i12�12 <br />(��iblic Warks F�oimd # hW17.(1!i=O�I <br />HudNinq PormR #; <br />nlanning Referenco tt <br />rubhc Works Fee S E 7.5.00 <br />Other 5. <br />APpLICANt NAME AND ADORESS: <br />I'RON711iR COMMUNIC�TIONS <br />tBDn a157 STrMCWA010a03 <br />EVtRE=7'1' WA 98201 <br />PMONE: �252G3A840 <br />S�TE ADDR[SS: 4619 RUCKER AVE <br />PERMIT CONDITIONS / <br />1 All calls for inspection shall be made 24 hours m advance <br />2 All work shail be performed in accordance wdh the permit and currenf Gty ot Everett Design and Construchon Standards <br />and Specificalions. <br />3 Call Location Underground Service 48 hrs belore you dig T FREE NUMBER 811 <br />4 Centacl Ciry inspeclor Randy Allen prior to sta•ting const�ct� n <br />5 Comply w�th mod�fied traffic control plan � <br />\ U' / <br />/ <br />/ \ / <br />�i <br />U <br />FINAL INSPECTION Date <br />Aooroved as Constructed <br />� , i,� <br />� i;, ;`; flil , - <br />, <br />� � fviAY D 5 2012 � � <br />� - <br />- ' ::RF � �. <br />i „ <br />ACKNOWLLDGLMLNT OF CONDITIONS <br />I he undersigned owncdapphcint hereby ayrces �o ho�d and <br />save hamiless Ihc Cdy ot Everett irom any and all claims for <br />damages, costs, ezpenses, or causes of adion Uial may anse <br />bec3�se o( installation and mamtenance ol Ihe improvemenl <br />or olher right-o(�way use hereto applieA (or and further agrees <br />lo emove same opon notice Irom the City and lo replace <br />p lic propeity damagzd thereby. <br />- � '� Z <br />Signaturc ot Applicanl Date <br />VVORK AUT}10RIZFD (iY THIS PERMIT MUST NE STARIED WITHIN I80 DAYS OF DAlE PERMIT IS ISSUED 4ND 7NEREAFiLR IS TO 8[ DIUGEN7lY <br />PURSU[D TO COMPl.ET10N. i1115 1�[RMII MAY HE UNC[LLED DY TNE CITY Uf`ON AYY STOPPAGE OF VJORK ON TNIS PROJECT OV[R 90 DAYS DURATTON. <br />