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PUBLIC�ORKS PERMIT � Date: 9/22/2015 <br />Public Works Permit #: PW1509-019 <br />City of Everett Public Works Department <br />3200 Cedar Street Building Permit #; B1509-036 <br />Everett, WA 98201 Planning Reference #: <br />(425) 257-8810 <br />Public Works Fee $: $ 80.00 <br />Other $: <br />OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br />GUSTAFSON DENNIS& KATHLEEN <br />1215 MADRONA AVE <br />EVERETT Wq 98203 <br />PHONE: 4253391571 <br />TAX PARCEL ID # 00505700003702 <br />RETAINING WALL <br />OWNER <br />PHONE: <br />SITE ADDRESS: 1215 MADRONA AVE <br />MAPLE HEIGHTS BLK 000 D-02 - BEG <br />PERMIT CONDITIONS SD <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. The contractor must meet with the Public Works Inspector to discuss potential drainage routing prior to <br />beginning the project. Call Randy Allen at 425-339-7403. <br />5. Install and maintain erosion control measures per City of Everett Standards and as determined by the Public <br />Works Inspector, such as silt fence, straw bales, swales, or erosion blankets. <br />6. No dirt, mud, rocks, or debris to be tracked onto roadway. <br />7. Contact the City of Everett Public Works Inspector Randy Allen �t �125-339-7�103 prior to starting construction <br />and with all other inspection requests. See attached to request an inspection. <br />Public Works Fee Breakdown: <br />Retaining Wall Over 4FT ($10/ft of ht over 4' per 100LF of length) $40.00 <br />Public Works Plan Review $20.00 <br />Public Works Site Inspection $20.00 <br />r Con <br />9 a3 ao�s <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and <br />save harmless the City of Everett from any and all claims for <br />damages, costs, expenses, or causes of action that may arise <br />because of installation and maintenance of the improvement <br />or other right-of-way use hereto applied for and further agrees <br />to remove saine upon notice from the City and to replace <br />public property damaged thereby. <br />/ � � � ` _ <br />INAL INS TION Date ' � � � ���� <br />Approved Constructed Signature of Applicant at <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS T E 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'..�-�e <br />