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PUBLIC WORK$ PERMIT <br />Date Applied: <br />2/1/2022 <br />Cityof Everett Permit5ery ices <br />Public Works Permi N: <br />PW220l <br />EVERETT <br />3200 Cedar 5[reeq 20d FI°°' <br />Evere[[, WA 98201 <br />Associated Bldg Permit #: <br />Planning Reference B: <br />WAARINCTox <br />42S-25T-S810 <br />Public Works Fee: <br />$233.94 <br />OWNER NAME AND ADDRESS: <br />APPLICANT NAME AND ADDRESS: <br />COMMUN ITY HEALTH CENTER OF SNO COUNTY <br />IANET MONDA <br />86N EVERGREEN WAY <br />EVERETT, WA, 982M <br />PHONE: <br />PHONE: 42582322" <br />TAK PARCEL ID B: W5822022WI01 <br />SITE ADDRESS: 4201 RUCKER AVE <br />DESCRIPTION: SITE WORK MOD TO ACCESS DRIVEWAY, REPLACE EXTG RETAINING <br />WALL. REFURBISHMENT OF LANDSCAPE IRRIGATION AND VEGETATION. <br />THIS PERMIT TO BE POSTED ON JOB SITE AT ALL TIMES <br />PERMNCONDInoxs: <br />1. An cells Par inspection shall be made 24 hours in advance. <br />2. All work Shan be performed In accordance with the permit and current City of Everett 'Design and Construction Standards and SpeaRcmons for <br />Development'. <br />3. Call Weston Underground Service 48 hours before you dig. The day you call does not count TOLL FREE NUMBER 811. <br />4.Site CMI Work to be done per plans approved by the City of Everett Public Works Department. Approved plans must remain on Ali at all <br />times. <br />5. Inspections are required for all stores Of construction.Visit the Chys Online Permitting Portal at pw.everet agov to formally request all required <br />Ins es ctlens. A handout 6 provided at permit Issuance with Instructions on how to request an Inspection online. <br />6. Install and maintain erosion wntrpl measures Per City of Everett Standards and per the direction of the PW Inspector or the approved <br />SWPPP/TESC Plan. Remove upon completion of the project priorto Mal approval of the Permit. <br />2. Keep 0 streets clean at all times. No dirt,mud,racks, or debris to be tracked onto roadway. <br />S. Protect all existing underground utilities dudngconstructlon. <br />9. Any damage to City improvements (sidewalk, curb, roadway, ete.) shall be replaced per City Standards and/or as directed by the City PW Inspector. <br />10. It is the appliwnJowne/s responsibiliti ensure thatstormwater runoff from new/replaced im"mious surfaces will be managed on -site in a <br />manner that does net adversely affect neighbodng properties, Including the City's right-of-way and/or easements and the Improvements located <br />therein. <br />11. Prior tp any interruption to the public right-of-way (roadways, parking lanes, or sidewalks) a Traffic Street Use permit shall be obtained from the <br />CItY4Tnfnc Engineering Division. this permit can be applied for online at pw.everettwa.gov and requires a traffic control plan to be submitted for the <br />area of requested dosure. Please allow 1-2 weeks for TSU permit issuance from the date of application. <br />12. This permit must be foaled in order to close Out this permit/grant a Certificate of Occupancy. Request a final inspection online by selecting PW <br />25-Site Final/Permit Close Out Saint the Online Permitting Portal Inspection Requests for this permit when all items he" been completed. <br />13. All work constructed within the public right-of-way must be removed or relocated at the owner'expense ITthe City ever requires use of the <br />FREE -of-way for municipal purposes. <br />Public Works Permit Fee Breakdown: <br />Erosion Control ............................................ $50.00 <br />Paving(123 SET ... ......................................... $45.00 <br />Retaining Wall(132LF).................................$66.00 <br />PW Plan Review ........................................... $20.00 <br />PW Site Inspection.......................................$20.00 <br />StormwMer System Development Fee........ $32.94 <br />Cry of Everett Metal Use Only ACKNOWLEW EMENT OF CONDITIONS <br />By purcM1asing tM1is permit and commencing work, the owner/applicant <br />hereby agrees to hold and save harmless the cry of Everett from any <br />and all claims for damages, costs, expenses, or causes of action that <br />may and maem tetanppliedthe <br />Imparisebeeau:eofmight-mon <br />ueeheremapanedaram mrmer <br />04/15/2022 agreest <br />romois sam upon away <br />agrees [o remove same upon notice from [M1e City and to replace <br />Approved for Construction, Public Works Dept. Date public property damaged thereby. <br />WORK AUTHORRIZED I THIS PERMIT MUST M STARTED WITH IN 110 ONES OF �n PERMIR IS ISSUEDAND THERMITER IS TOM Di�E�y PURSUED TO CMPLMON. THIS PERMIT MAY UP CANCELED By THE <br />off UPON My STUPPAGE OF WORK ON THIS �IEU�R IMETAY DURATROINE � INW�M Emi THE EXPIRATION DUM Iff) Doe TO KEEP THE PMMff OPEN We a WORK 15 ACTIVE <br />_APPLICANT/1011 SITE COPY _TREASURER _ADDRESS FILE <br />