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Date <br />Application For <br />�UBLIC WORKS PERMIT <br />Print or TypE Only <br />Owner <br />Plan Check No: B 49332 <br />Applicat.Date: 08/28/95 <br />Job Address: 76b1 EVERGREEN WAY <br />Owner: VYZIS COMPANY <br />Tenant: CHANG'S MONGOLIAN <br />Ptoposed Uae: RESTAURANT <br />Deac. of Work: <br />TENANT IMPROVEMENT <br />SEPA <br />GRILL <br />Applicant P��; <br />P�OBFICE SET JOB SET <br />p`KS`i���� <br />DescribeUr��t,�ei�mK'iV ppp ED FOR PERMIT: DATE_/_I_ BY <br />\'r% _ / <br />t�'( <br />PUE11c Wa�ks Pormlt • <br />B�du.Decl + <br />PuolicworkaFoa � <br />Total Fco <br />Lese ApO� Feo Pa1E S <br />palance Ouo 5 <br />Phone <br />� Phone <br />Project Address (il known) — <br />Atlach tour (4) copies of plans lor proposed work - Draw to scale and nole the loltowing as applica6le: <br />• Properly Lines <br />• Outline and dimensions of all exisling and <br />proposed structures on Ihe lot <br />• Exisling and proposed utilities <br />• Centedine of slreet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />✓_ _ , ��BIIG '�40�QUIRE�. <br />PERMITCONDITIONS �,S p R��T p <br />1. All calls tor f��se��{i �shMIQ�•��e��t hrs. in adv�c'e- pi�one 259•881 <br />2. All work shall b�, p r� 1neB ��bCbr ance with lhi ei �6dcurten ity�relt Desigr� and Construcllon <br />SlandardsandSpecificalions. �" � <br />3. Call Location UqSIP19��+^d S'er`vice 48 h�s. b�fore yo3 dig. T4LL FREE NUMBER 1-800•424•5555. <br />, n'i F _ . ,.-.. .. . <br />_..�- <br />�u��,`�,�+��'1��'�"� <br />�.:�.ri'.� <br />�fY�---�'�" f_�� <br />� UdIIG ��'RE�UIRE^ M1rQy�'�;E.�""' <br />� pi <br />' �-_,,. <br />:.Y �-""_` .....1'"_ <br />un'lE.....�- <br />Approved lor Construction <br />Date <br />FINAL INSPECTION Dale <br />Approved as Construcled <br />�A��p� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evercll, WA 98201 <br />Phonc:259�8E10 <br />\VOP.KS PERMIT <br />rU(i `�G � RE(]UIRED <br />1Y—=�� 2q <br />�] A'f E /7� <br />ACKNOWLEDGEMENT OF COIJDITIONS <br />Z <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees lo hold and save harm� <br />less �he Cily of Everett Irom any and all claims tor damages, costs, <br />expenses, or causes of action that may arise ber_ause of i�slal�ation <br />and maintenance of the improvement or other righ4ol•way use hereto <br />applied lor and turther agrees to remove same upon nolice Irom lhe <br />City and to replace public property damaged Ihereby. <br />Date <br />Signature of Applicanl <br />80R AYS OF DATE PERMIT ISE SSUED AN1D THEREA TER ISHTO <br />BE DILIGENTI.Y PURSUED TO COMPLFTION. THIS PERMIT MAY BE <br />CANCELLcO BY iHE CITY UPON ANY STOPI'AGE OF WORK ON THIS <br />PROJECT OVER 90 Di�.YS DURATION. <br />