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_��2 `j <br /> i <br /> DB�O_ PuEu<Worh�permn• C 7 <br /> Applicetion For e�oa oso� . 37428 <br /> PUBLIC WORKS PERMIT P�����M�orh�Fee <br /> Totel Fee f <br /> LeaaAoo� feeP�id S <br /> Print or Type Only <br /> eniaoceooe S ..7�� <br /> Boeinq Co. PO Box 3707 M/S OF-76 Seattle, WA 98124 �tn�_�aaq <br /> Owner Mailing Address City Lip Phone <br /> owner <br /> Applicant Mailing Adtlress City Zip Phone <br /> DesCribBPropoSedWo:k 'iMi v rna{n.. na _ nta9 nn_m <br /> rnnn=NC L10CY &7iPADISi6AI _ _. <br /> Project Address lif known) 40-03 � <br /> Attech lour(4)copies of plans for p�oposad work-Draw to scale and note the lollowing os applicable: � <br /> • Property Linas • Centerlina ol st�eet � <br /> • Oulline and dimensions ol all existing and • Indicate Norlh <br /> proposed etructures on Ihe lot • Shuw any proposed preding chan�es <br /> � Existing and proposod ufllitiea • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls lor Inspaction ahall be made 24 hra.ln advance•phone 259•6810. � <br /> 2.All viork shall be performed in accordanca with this permit end cwrent Clly of Everett Design and Conetructlon <br /> Standa�ds and 9pecillcatlons. <br /> 3.Cell Locatlon Underground Service 48 hra.belore you dig.TOLL PREE NUMBER 1•800�424•5555. � <br /> T� �GC.�i CG-[7�iCU �F UCI)uri ��'✓ �O-n.f� CZF�yGJr7�lc�, O <br /> [ ( [� r � / �� / <br /> ll.c/ CG�C•2C��C�GC<C� /L�Al�`- c'v�-- h��- fl� /�[��./ .2.!/rtr/4'c� <br /> 1 C � <br /> � <br /> � �s��'�C O <br /> ;�;���� �� <br /> 1� �.��, �`� 1g92 °- <br /> n..... Ev�FzL�•pnS . <br /> ACK��yld.ey1GEfQJYNS'DF CONDITIONS <br /> .��,�r•�� <br /> The undersigned own� �icant hereby agrees to hold and save harm� <br /> / less the Cfly of Everett Irom any and all claims lor damages, cosis. <br /> eaperses. or cauaos ol action that may erise because ol inetallation <br /> � ���r,.h�_ R��l and maintenance of ihe improvement or other iight�ohwey uee hereto <br /> Approved 9r Constr '/tion Date applied lor and lurther agrees lo remove same upon nolice Irom thu <br /> F��`t' 1���� ���� CitY and to rePlace Public P�oPertY damagod Ihereby. / <br /> A INSPECTION , �a�e Ci��`'"�r�R�`r�' //`�i�'"'�� X/ %/;Z. <br /> Approvod as Canstructed --� <br /> Signalwe ol Appli t �D.ile <br /> PUBLIC WORNSDEPARTMENT WORK AUTHOFIZED BY THIS PERMIT MUST BE STAHTED WiiH1N <br /> 3200Ceda�Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER lu TO <br /> Everett.WA 98:01 BE DILIGENiLY PURSUED TO GOMPLET�ON. THIS PEFMIT MAV 3E <br /> Phono:259�8810 CANCELLED BY THE CITV UPON ANY STvPPAGE OF WORK ON THIS <br /> PROJ[CT OV[R 90 DAYS DURATION. <br />