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Application For <br />2�' % <br />OL <br />PUBLIC WORKS PERMIT <br />Date <br />PUBLIC WORKS DEPARTMENT <br />Public Works Permit <br />M <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 FEb L 4 <br />Building Permit M <br />i <br />TO POSTING <br />Public Works Fee$_ <br />�8g� <br />TYPE OR PRINT ONLY <br />Dave Michaelis, <br />Michaelis & Co. 1430 E. McAndrews Road lit <br />Medford, OR <br />97504 <br />Owner <br />Mailing Address city <br />Zip <br />Phone <br />Karl Lundberg <br />Barghausen Engineers <br />18215 72nd Avenue S. Kent <br />WA 98032 <br />(425)251-6222 <br />Applicant <br />Mailing Address City <br />Zip <br />Phone <br />Describe Proposed Work Fill and <br />future storm <br />site; construct temporary storm drainage and <br />e in deep fill areas. C <br />PROJECT ADDRESS (if known) <br />r. A ♦ l/ n <br />MW 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 if applicable: <br />•Property Unes '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 1-800-424-5555. <br />!�. o�lp/t,,t� p/C.Wts Qill�� T-` f14-22�8'9:19AM <br />4 98092 OTHER 1021.5;AU vtC <br />PU/RVU 1086.20 J <br />PU/iNSP 6788.75 <br />TOTAL 8896.45 <br />Cf-fIEK <br />A OM5536 <br />CA <br />ca <br />0 <br />Oil <br />0 <br />CA <br />0 <br />a <br />ACKNOWLEDGEMENT OFCONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace publA: property <br />damaged�iareby. <br />lox, <br />Sidnatur6 of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THE/WrER 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 />