4512 FOREST DR A T AND T WIRELESS ANTENNA 2018-01-01 MF Import

P�JBLIC WORKS PERMIT Date: 05/11/2009 Public Works Permit#: PW0905-010 City of Everett Public Works Department �y 3200 Cedar Street Buildinp Permit#; B0905-011� h � Everett, WA 98201 � � �U (425) 257-8810 Planninp Reference#: Public Works Fee $: $ 2�0(f v Other$: OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: OUR SAVIOR'S LUTHERN CHURCH 4512 FOREST DR EVERETT Wq 98203 PHONE: PHONE: TAX PARCEL ID# 00449400201000 SITE ADDRESS: 4512 FOREST DR DESCRIPTION OF PROPOSED WORK: REPLACE 3 ANTENNAIADD 3 RET'S -AT&T PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hours in advance. 2. All work shall be performed in accordance with the permit and current City of Everett Design and Construct?on Standards and Specifications. 3. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 811 4. Tra�c control per current MUTCD Standards. r-:i �-`1 _,� YOUR INSPECTOR IS RANDY ALLEN 425339-7403 ' � r:i � -- - ,-,i� -- � .�� ' � '�' � 4J OLT� � __.` f i � � ' � il �,� ,._ ,;z �; '��o �� =H � ,�, _� .�,�� L,,1.,� ,� rO :�lil'y __1 __ •.1 ,�: ::a -=,:_:, : ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless the City of Everett from any and all claims tor damages,cosls,expsnses, or causes of action lhet may arise ,% because of installation and maintenance of the improvemen! , e/Q�hz�z •s—/� O� or olher right-of-way use hereto applied tor and tuAher agrees A ed r onst� e!i Date to remove same upon notice from the City and to replace PP public property damaged thereby. NAL INSP TION � I �� `_ ` � _ 2� �� Approved a Constructed Signature of Applicant Date WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF GATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO COMPLEfION. THIS PERMR MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. "1