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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: B 37930 SEPA <br />App).icat.Date: 09/03/92 <br />Job Addrs: 3003 W CASINO RD 40-23 <br />Owner: BOEING <br />Owner Tenant: <br />Proposed Use: PNEUMATIC TUBE CONTROL <br />Den. of Work: <br />PNEUMATIC TUBE PENTHOUSE - T.I. <br />Applicant <br />OFFICE SET JOB SET <br />Describe Proposed Work APPRVD FOR PERMIT: DATE_/_/_ By__ - <br />Project Address fit known) <br />Pablhc WPIFa Petmil e <br />Bldg Deol <br />PPbbc Wod,s Fee $ <br />Total Fee <br />Less.LGPt Fee Paid $ <br />Balseee Due s <br />Zip Phone <br />Zip Phone <br />Attach four (4) copies of plans for proposed work • Draw to scale and note Centerline as sop <br />of sheet; able: <br />• Prof arty Lines • Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. In advance • phone 259.8810. <br />2. All work shall be performed In accordance with this permit and current City of Everett Design and C instruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424•tA55. <br />14?1 OIi"P �OL2iwr /ria �iP�caud <br />9� 9z <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />&L PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreel <br />Everett,WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />z <br />O <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of the impro,•ement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant uate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 JAYS OF DATE PERMIT S ISSUED <br />BE DILIGENTLY PURSUED TOIDTHEREAFTER <br />COMPLETION.THISPERMIT MAY E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />