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PUBLIC WORKS PERMIT <br />City of Everett Public Works Department <br />3200 Cedar Street <br />Everett, WA 98201 <br />(425) 257-8810 <br />OWNER NAME AND ADDRESS: <br />BETHANY CHRISTIAN ASSEMBLY-EVERETT <br />2715 EVERETT AVE <br />EVERETT WA 98201-3754 <br />2 1 JUN 2017 <br />Date: 1 /19/2017 <br />Public Works Permit #: PW1701-016 <br />Parent Permit #: B1612-002 <br />Planning Reference #: <br />Public Works Fee $: $ 65.00 <br />Other $: <br />APPLICANT NAME AND ADDRESS: <br />BECKY TODD <br />PHONE: ( PHONE: 2063101793 <br />TAX PARCEL ID # 29052000406900 1 SITE ADDRESS: 2715 EVERETT AVE <br />SITE WOR FOR REPLACEMENT UTILITY POLE <br />Site work associated with replacing an existing utilitiy pole with a larger pole and installing 3 panel antennas. Covers hard <br />surface restoration and trenching. <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hours in advance. <br />2. All work shall be performed in accordance with the permit and current City of Everett Design and Construction Standards <br />and Specifications. <br />3. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 811 <br />4. Site Civil Work to be done per plans approved by the City of Everett Public Works <br />Department dated 1/19/2017. <br />5. Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior <br />to starting construction and with other inspection requests. <br />6. Temporary erosion and sedimentation control measures for construction activity must <br />be operational prior to commencement of any dirt/paving removal or replacement. Must <br />be removed upon completion of the project. <br />7. Keep City streets clean at all times. No dirt, mud, rocks, or debris to be tracked onto <br />roadway. <br />8. Protect all existing underground utilities during construction. <br />0�, <br />9. Any damaged sidewalk shall be replaced to meet current City standards (#306). <br />€ <br />10. Traffic Control Plans must be submitted to the City of Everett Permit Services <br />Counter (Public Works reviewers) for review and approval prior to any interruptions to <br />JUN 2 1 2017 <br />the roadway. <br />Public Works Permit Fee Breakdown: <br />Misc. Minor Permits..................................$25.00 <br />PW Plan Review.......................................$20.00 <br />PW Site Inspection....................................$20.00 <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />CITY OF EVERETT <br />Permit Services <br />C <br />0.1 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless the <br />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 the <br />improvement or other right-of-way use hereto applied for and further agrees to <br />remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Dat <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY <br />PURSUED TO COMPLETION, THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />F� <br />