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Date <br />Application For <br />PUBLIC Vlt'�JRKS PERIViIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />Project Address (if known) <br />Plan Check No: B 43291 SEPA <br />Applicat.Date: O1/19/94 <br />Job Addrs: 316 SE EVERETT MALL WY <br />Owner: PEGRAM MIKE <br />Tenant: MCDONALDS <br />Proposed Use: RESTAURANT <br />Deac. of Work: <br />B X 9 ADDITION TO INSTALL NEW SERVICE <br />WINDOW <br />OFFZCE SET JOB SET <br />APPRVD FOR PERMTT: DATE_/_� <br />Attach four (4) copies of plans for proposed work • Drew to scale and note the following as applicable; <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />Pu�lic 1Voiks Pe�mi� s <br />910g. Depl. a _ <br />Pubi¢ Works Fee <br />Total Fee $ _ <br />Ll45 Appl. Fee PaiC � � <br />sam�« m e s _ <br />• Centerline of streel <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be perfo�med in accordance with this permit and current City of Everelt Design and Construct(on <br />Standards and Speci(ications. <br />3. Call Location Underground Service 48 hrs. before you dip. TOLL FREE NUMBER 1-$00•Q24-5555. <br />PUBLIC WORKS PERMIT <br />NO�EpUIRED <br />BY <br />DATE_ a� � s[. <br />Approved tor Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />��PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA g8201 <br />Phone:259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />0 <br />The undersigned owner/spplicant hereby agrees to hold and save harm- <br />less ihe City of EvereU from any and all claims for tlamages, costs. <br />expen,es. or causes of action that may arise because of installation <br />and malntenance of the improvement or olher right-ohway u�e hereto <br />applied for and further agrees lo remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUI�HORIZED BY THIS PERMIT MUST BE STARTED WI7HIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />