3429 15TH ST 2016-01-01 MF Import

� - � , . � PUEI¢Works Permit a �� , Date�2L�4 eiaa oea •�C�-6" — qpplication For --� pUEUrC WORKS PE�MIT Pubi�cworkaFeo �_ _ Total i ne Less ApO�-Fee Paitl 5 Balance Duc $ Print or Type Only Burlington Northern RR 176 E Sth St St Paul MN 55101 612-Z98-3300 phone Owner Mailing Address City Owner ZiP Phone Applicant Mailing Address Ci�y Describe Proposed work microwave tower & equi ment shelter __. — W 3429 15ch St � Proiect Address(it kno�vnl � � Atlach tour(4)copies of plans tor proposed work- Draw to scale and note�Ce��eµrline o(str�ee� able: � • Property Lines • Indicale North '�.. � � • Outline and dimensions of all existing and � Shov. any proposed grading changes ' ' proposed slruCturec on lLe lOt � Show measuremenls M � • Exis�ing and proposed ulilities W DO NOT WRITE BELOW THIS LINE � � � PERMIT CONDITIONS � 1.All catls for inspeclion shall be made 24 hrs.in advance-phone 259•8810. 2.All work shall be performed in accordance with this permit and currenl City oF Everett Design and Construclion � Standards and Specifications. �y 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800'424•555 • � O ��v �I� 1� � Wor Ks p�-M-V � /z��;,-�- I- I v �G� �i � vV— — O �/z/� a ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- — less Ihe Giry of Everetl irom any and all claims for damages, costs, ezpenses, or causes of action that may arise because ot instalialion and maintenance ot the improvemen[ or other righFof-way use herelo applied tor and further agrees to remove same upon notice from the Approved (or Conslruclion Date �ity and to replace public prouerry damaged thereby. FINAL INSPECTION Dale Date Signature ol Applicant Approved as Conslrur.led y,�pRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIl'HIN �r7 PUBLICWORKSDEPARTMENT 7g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO �� 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE �� Ev�ret6 WA98.^Ot CANCELLED 3Y THE GTY UPON ANY STOPPAGC OF WORK ON THIS Phone:259�8810 PROJECT OVER 90 DAYS DURATION.