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� <br />�E � TT <br />PUBLIC �ORKS 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 />NAMBA, LARRY <br />510 ALLEN ST, STE B <br />KELSO Wq 98626 <br />PHONE: 2066180753 <br />TAX PARCEL ID # 29051700200700 <br />REMOVE MONITORING WELLS <br />Date: <br />Public Works Permit #: <br />Building Permit #; <br />Planning Reference #: <br />Public Works Fee $: <br />Other $: <br />APPLICANT NAME AND ADDRESS: <br />NAMBA, LARRY <br />510 ALLEN ST, STE B <br />KELSO Wq 98626 <br />PHONE: 2066180753 <br />SITE ADDRESS: 851 N BROADWAY <br />10/13/2015 <br />PW1510-022 <br />$ 45.00 <br />REMOVE 3 MONITORING WELLS (2 IN PARKING LANE AND 1 IN CENTER TURN LANE) AND RESURFACE AREA. <br />PERMIT CONDITIONS <br />1. Ail calis 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 />,; <br />4. Traffic control per City of Everett Standards. -: ;--, <br />5. Surface restoration must match existing surface and be done in accordance with current City of �ver�tt Desi,gn <br />and Construction Standards and Specifications for Development. <br />6. 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 />F'ublic Works F'ermit Fee Breakdown: <br />Misc. Minor PW Permit $25.00 <br />PW Site Inspection $20.00 <br />�c� � �6 ao�s <br />Approved for Construction Date <br />� :::� : ''' <br />;.} ,�,5 , <br />,��, -- <br />' ��a �.-� <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 />FINAL INSPECTION Date ��i 1� L'� �: -(��T .2c-� S <br />Approved as Constructed Signature Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND TFIEREAFTER 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 />��� <br />