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Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />M 2420 <br />TYPE OR PRINT ONLY TO POSTING------- <br />Dateld - z D ^ 7 <br />s4o <br />Public Works Permit M <br />Building Permit k <br />v� <br />Public Works Fve $ 46'r <br />Dave Michaelis, Michaelis 6 Co. 1430 E. McAndrews Road #1. Medford, OR 97504 <br />Owner Mailing Address City Zip Phone <br />Karl Lundberg <br />Barghausen Engineers 18215 72nd Avenue S. Kent 98032 (425) 251-6222 <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Grading, storm drainage <br />and off -site retention pond. <br />PROJECT ADDRESS (if known) NW Corner of 19th Avenue SE and 100th Street SE <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following Iapplicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot "Existing and proposed utilities <br />'Centerline of street •Indicate North 'Show any proposed grading changes 'Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5666. <br />. S! <br />lect.r� plc ��e Gr vtc� �►T 1�� ayl d <br />C. No CoNsmocttap.) Acriv)rf cAAJ pccc,. 10-28-97 4:11PM <br />0 <br />w41h �e dd4likD W£4-411,"fs fix�±fJhL "OTHER 200.00 4*t ill sec tAIS -At R PA &A-41i OTHER 100.00 <br />OTHER 165.00 <br />TOTAL 465.00 <br />e for!5 n Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />CHEK 465.00 <br />ArKNOWLEDGEMENT OF CONDITIONS <br />The undersignno owner/applicant hereby agrees to hold and save harmless <br />the City of Evrrett from any and all claims for damages, costs, expenses, or <br />cau,es of act.on that may adse because of installation and maintenance of <br />the improvemant or other right-of-way use hereto applied for and further agrees <br />to remove sjone upon not T <br />City and to replace public properly <br />dame reby. Aip % <br />M <br />S� ure of Applicant/)' ��� <br />407Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />