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��. ,�... <br /> � <br /> � <br /> Applicatlon Far � <br /> PUBL[C WORf�S PERMiT Date �z-a-9s__ <br /> ,. _ <br /> �— PUBLIC WORKS DEPARTMENT <br /> 3200 Ceda, Street P�blic Works Permit# __ - O/ <br /> Everett,WA 98207 259-8810 <br /> Building Permit# 50174 <br /> T'fPE OR PRINT ONLY n <br /> Public Wcrks Fee 3 -�� � <br /> Burliagton Northern :900 75ond St EvereCt 98201 <br /> O�vner Mailing Address <br /> ���Y Z�P �hone <br /> AT&T Corp for Starcom International A.J. Sullivan (360) 366-7201 <br /> Applicant Mailing Address Cit <br /> y Z�P Phone <br /> Describe Proposed Work site work for fiber opti.c station B � � <br /> W <br /> � <br /> �. <br /> PROJECTADDRESS(ifl<nown) z701 36th St � <br /> Attach four(4)copies of plans!or proposed wcrk-D;mu to scale and note the following i�applicable: � <br /> •Property Lines •Outline and dimen;ions of all existing and proposed structires on the lot •Existing and proposed utilities � <br /> •Centedine of slreet •Indica�a North °Show any proposed grading changes •Show measuremenis <br /> µ DO NOT WRITE BELOW THIS LINE � <br /> PERR4IT CONDII�C�JS: � <br /> 1. All calls for insoection shall be made 24 hours in advance - phone 259-8g10. <br /> 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and O <br /> Construction S;andards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-8J0-424-5555. <br /> ' 7 r ' ♦�^ <br /> - �� ����y sf����r�s ���<< :� � 2c � <br /> � � [ f,i�,:.s. V d <br /> � <br /> � <br /> �,,,`.,,�.r, __ �:,- - , <br /> �00096Q?1 <br /> nruc^, c-�•c � <br /> l` • <br /> > ACKNOWLEDGEMENT OF CONDITIONS <br /> �/ � The undersigned owner/applicant hereby agrees to hoid nnd save harmless <br /> � � ihe City of Everett from any and all claims for damages,cosis,expenses,or <br /> Ao rov 16r o ru ' n Date causes of action ihat may arise because of installation and maintenance of <br /> � . � iheimprovemeNorotherright-of-wayuseheretoappliedforandfurtheragrees <br /> _� � �� lo remove same upon notice from ihe City a�d to replace public propeAy <br /> — damaged thereby. <br /> FINAL INSPECTION Date <br /> Appmved as Constructed <br /> i � <br /> "L_�Ci <br /> Sig ture of App can Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE ST4RTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUFD AND THEREAFfER IS TO BE DILIGENTLY PURSUED TG <br /> COM1�1PLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITV UPON ANY STOPPAGE OF VJORK ON THIS PROJECT OVER 90 DAYS DURATICN. <br /> � .__ , <br /> ..�- . . _ .-_�`F'+�-�i�, . t^-' ,.. ,�...� _ . . <br /> _ . . . � i j� � f� � - r�Y �� , ._ 71 .� .. <br /> � I( _ �. , ���1 <br /> 1 <br /> — ,o� � ...,�.._ Si . <br />