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�: <br /> 12�29�92 a„m�c wo�xe aamu. <br /> Date � ' e,ao oep, _ 39116 <br /> Application For <br /> ��� PUBLIC WORKS PERMIT '°°"`"'°",F`° 5 <br /> ToiaiFee <br /> Lev AoO�Fee Pm0 S <br /> A�x p��,�nce Duc 5 <br /> ��y Print or Type Only <br /> Kzn <br /> � �� Michael R Scanes 2027 Grand Ave Gvere[t 98201 252-2761 <br /> � H'TJ Ov+ner <br /> A1aJing Atldress C�tY 7_�p Phone <br /> �/1 H <br /> mMz <br /> '" �� Ma�lin9 Adtlress C�ry Z�P Phone <br /> H C7 APPlican� <br /> OH <br /> � �,g <br /> �" n oescrlbe Proposed Work New �'araKe, retainin wall <br /> � y� <br /> 8 H — W <br /> � d� � <br /> C"� 2027 Crand Ave <br /> 3. �� proiect Address UI knownl -- ----"—�- -- <br /> : � <br /> z y N Attach lour 141 coP�es of plans for proposed wo�k� Drav: to srai�� ,r��� ������".^�lo�lowing as applicable�. � <br /> H O Cp • CeNcrhne ot sireel <br /> • Property Lines • indicale North <br /> • Outiine and d�mensions ol ail ex�stmg antl � Snow any nroPosed 9ratling changes <br /> proposed slructures o��he lot • Show measurements M <br /> • [xis�in9 and p�oposed uldd�es W <br /> O <br /> '—s PERMIT CONDITIONS � <br /> 1.All calls lor inspection shall be ma� gn and Construction <br /> �' 2.All work shall Ue pedo�med in accc <br /> Standards and Speciiications. �-424•5555. � <br /> 3.CaIILocationUndergmund5ervic� �y�71AL INSPEC710N <br /> �.., � KIRK BROOKS O <br /> OATE l�- - :J '; i:7- � <br /> ....,,, f ' <br /> . � � � <br /> PUBLIC WORKS PERMIT ^ �,U � �! . <br /> NOT REDUIRED � � i�� O <br /> � � � �� (� <br /> BY_. -_`v,-!i �.n .\,� � i ,� <br /> � <br /> , ;, . ,�� `, e 1, �� a <br /> DATE � \ <br /> �d�� <br /> ACKNOWLEDG[WENT OF CONDITIONS <br /> �� <br /> The u�tlersigneA owner/applicnnt here�y agrees to hold and save ha�m- <br /> — less Ihe Cdy of Everet� Irom any and a0 claims lor dama9es, r,osts. <br /> e*pensee� or causes ol .ction that may arise because ol installalion <br /> . anA mamtcnonr.e of Ihc improvement or olher ri9h4ol�way usc herelo <br /> ,i�_phed lor a;�'. ��������r agrees lo icmove same uPon nolico fiom the <br /> App�oved lor Construction <br /> Date Ci•y:ind to ruPlace puhhc ProPi��Y Jamaged thereby. <br /> FINAL INSPECTION ��10 --"—" Date <br /> Swnatwc o�APPhCan� <br /> qpproved ns Conslructed <br /> t� WORK AUTIIORIZED BY THIS PERMIi MUST BE STAPTED WITN� <br /> �p,/J PUBLICWORKSDEPARTMENT 1B0 DAYS OF �ATE PERAIIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DIUGEN7L1' PURSUED TO COMPLETION.THIS PERMI7 MAY B[ <br /> Gverelt WA 98201 CANC[LLED BY TH[CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />