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AppliCalion ; or <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Appiltant <br />Describe Proposetl Work <br />Project Address (if known) <br />Plan Check No: 8 4"I7tl0 <br />Appllcat.Date: 03/20/95 <br />Job Addrees: 615 112TH ST SE <br />Owner: KTM ALEX <br />Tenant: JIMMY'S PI22A & <br />Proposed Uee: <br />Desc. of Work: <br />CONSTRUCT PORTABLE DECR <br />SEPA <br />PASTA <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_�_�_ gy <br />Pubfc Wan� Pumll • <br />BIEp. D�OL � __ <br />Pu01rC War4 f�� <br />To1�IF�a S <br />L�ff Appl F�� p�l� S <br />e.i.��. o�. S �_ <br />Altach lour (4) copies of plans lor proposed work - Draw to scale and note the following as applicable: <br />• Properly �ines • Centerline of slreel <br />• Outline end dimensions of all existing and • Indicale North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existlnp and proposed utilllies • Show measuremenls <br />Phone <br />P�one — <br />PERMITCONDITIONS <br />1. All calls !or Inspectlon ahall be made 24 hrs. In edvance • phone 259-881 O. <br />2. All work shall be pe�farmed In accordance wilh Ihla permtt and currant Cily of Everett Design and Constructlon <br />Standards and Specillcationa <br />3. Cell Locatlon Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />i UBLIC WO�iKS PEPMI t <br />hOf HEOUIREp <br />,nT�.�t.7-.— - <br />Approved lor Conalruction Date <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />PUBLIC WORKS DEPARTMENT <br />- 3200 Cedar Streel <br />[verett, WA 90201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONOITIGNS <br />W <br />� <br />�w <br />_ / <br />�1 <br />� <br />� <br />O <br />r <br />v+ <br />0 <br />a <br />ihe undersigned owner/applicant hereby agrces �o hold and save harm• <br />less Ihe Clly ol [veretl Irom any entl all claima lor dameges, cosis, <br />ezpenses, or ceuses of action thal may arise beceuse of installation <br />and maintenance ol Ihe improvemenf or olher ri;7hl-ol-way use hcrelo <br />applied lor and lurthr.r agrees to remove same upon notice Irom the <br />Cify and to replace public property tlamaged Ihereby. <br />Signature ol <br />Date <br />WORK AUTHOR12E0 BY THIS PERMIT AfUST DE STARTED WITHIN <br />780 DAYS OF OATE PEqMITIS ISSUED AND THEREAFTER IS TO <br />P.E DILIGENTLY PUi7SUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED �Y THE .:ITY UPON ANY STOPPAGE OF WORK ON THIS <br />FROJ[CT OVER g0 DAVS DURATION. <br />