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P U B L I C�O RKS P E RM 1 T Date: 11 /3/2015 <br />Public Works Permit #: PW1511-005 <br />City of Everett Public Works Department <br />�� 3200 Cedar Street Building Permit #; <br />Everett, WA 98201 Planning Reference #: <br />(425) 257-8810 <br />Public Works Fee $: $ 150.00 <br />Other $: <br />OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br />KOZ EVCC LLC <br />1208 TENTH STREET ST#201 <br />SNOHOMISH �/�/q 98290 <br />PHONE: 2067551290 <br />TAX PARCEL ID # <br />TRENCHING IN THE RIGHT-OF-WAY <br />(11/3/2015 9:52 AM BES) <br />TRENCHING IN THE RIGHT-OF-WAY <br />SAM E <br />PHONE: <br />SITE ADDRESS: 1004 BROADWAY <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. Any damage to sidewalk, driveway etc.. should be replaced per City of Everett Standards. <br />5. There should be at least a minimum of 5'(five feet) separation between City of Everett utilities and directional <br />boring. <br />6. No dirt, mud, rocks, or debris to be tracked onto roadway. <br />7. Construct per approived plan 11/3/2015. <br />9.Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior to starting construction <br />and with other inspection requests. See attached to request an inspection. <br />Public Works Permit Fee Breakdown: <br />PW Plan Review $20.00 <br />PW Site Inspection $20.00 <br />Cut/Bore Street/Alley Parallel(LNFT) $110.0 <br />.,;;;� ::� <br />�- II �_� .F}F ; <br />' � i-.... r._ � � <br />.::� ��� _� <br />�... <br />,,_� .; <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 same upon notice from the City and to replace <br />public property damaged thereby. <br />� � "� � � ���% R�. J" ' �-s <br />Signature of Applicant Date <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 COMPLEI�ION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />