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� <br />�- <br />��� rr <br />� <br />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 />Everett Elks Lodge #479 <br />2802 Hoyt Ave Suite 100 <br />EVERETT VVq <br />PHONE: <br />TAX PARCEL ID # <br />• Date: <br />Public Works Permit # <br />Building Permit #; <br />Planning Reference #: <br />11/18/2015 <br />PW 1511-025 <br />Public Works Fee $: $ 25.00 <br />Other $: <br />APPLICANT NAME AND ADDRESS: <br />ESTIE JOHN <br />2802 Hoyt Ave Suite 100 <br />9820� EVERETT Wq <br />Renew Existing Water Service <br />Install water service in unopened 34th Street Right of Way. <br />PHONE: 4252526623 <br />98201 <br />SITE ADDRESS: 3400 Norton Ave <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 />T1 <br />_.v �; <br />4. No dirt, mud, rocks, or debris to be tracked onto roadway. �:�� ;-.+. �_ i ' <br />�`'4 — , L .�; . <br />�..� ..� <br />5. Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior to starting;;,,�onstructic�ti <br />and with other inspection requests. `=� <br />; ;; <br />.�7 <br />6. Restore area to like or better condition. <br />7. Install �iping a minimun of 24" deep. <br />8. Work to be done per attached drawing. Use 200psi Poly Pipe. <br />Public Works Permit Fee Breakdown: <br />Misc. Minor Permits $25.00 <br />� ` // —�' —/S <br />� <br />Appr'ved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />.����.�., .. <br />�-, <br />j-r; <br />�� <br />h� <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />T`� <br />V1 <br />O <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 />�' ��c�- /� z� �1 � <br />�i nature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND Tf iEREAFfER 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 />� VC/ <br />