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p Z <br />PUBLIC �ORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />TYPE OR PRINT ONLY <br />1 <br />Ld <br />Public Works Permit M <br />Building Permit *_ <br />Public Works Fee $ <br />Owner Plan Check No: B 61636 SEPA 93-98 <br />Applicat.Date: 02 18 99 <br />Job Address: 9610 19TH AVE SE <br />Owner: TRICOMM NW . <br />Tenant: <br />Applicant Proposed Uset TELECOMMUNICATION TOWER <br />Done. of Work: <br />CONSTRUCT 150' TELECOMMUNICATION TOWER (SPU <br />Describe Proposed Work _ 17-98 ) <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />PROJECT ADDRESS (f known) <br />Attach four (4) copies of plans for proposed work - Draw to male and note the following if applicable: <br />Phone <br />•Property Lines `Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilhies <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 1-800-424-5565. <br />R4iilk: W <br />a Y, 0T GUp,KUIRs6 <br />s RMI'i <br />fi <br />DATE.__ <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />() <br />ca <br />0 <br />z <br />0 <br />0 <br />a <br />ACKNOWLEDGEMENT OFCONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save hannlesa <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 orother right-of-way use hereto applied for and further agrees <br />to remover 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 THEREAF FEA IS TO BE DILIGENTLY PURSUEDTO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />