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/040 <br /> r "E PUBLIC WORKS PERMIT Date: 7/15/2016 <br /> City of Everett Public Works Department Public Works Permit#: PW1607-028 <br /> ,,, . 3200 Cedar Street Parent Permit#: <br /> Everett, WA 98201 <br /> Planning Reference#: <br /> (425) 257-8810 <br /> Public Works Fee $: $ 25.00 <br /> Other $: <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> TAIWO OLORUNNIWO TAIWO OLORUNNIWO <br /> 10022 12TH AVE SE 10022 12TH AVE SE <br /> EVERETT WA 98208 EVERETT WA 98208 <br /> PHONE: 4255304710 PHONE: 4255304710 <br /> TAX PARCEL ID# SITE ADDRESS: 10022 12TH AVE SE <br /> CONCRETE AREA IS 10 FT X 24FT LOCATED IN BACK OF HOUSE <br /> INSTALL CONCRETE PATIO IN BACKYARD <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 n; <br /> LI"? <br /> H <br /> 4. It is the applicant/owner's responsibility to ensure that stormwater runoff from new I^ <br /> impervious surfaces will be managed on-site in a manner that does not adversely affect m r, w <br /> neighboring properties, including the City's right-of-way and/or easements and the <br /> improvements located therein. l--I <br /> m i-n,—•) <br /> 5. It is the applicant/owner's responsibility to ensure that any Home Owner Association ,—.! ;� <br /> policies are adhered to. The City does not check for this aspect of the proposed work. <br /> 6. An inspection by the City Public Works Inspector is not required for the work. <br /> r <br /> Public Works Permit Fee Breakdown: ori 001 <br /> Misc. Minor Permits $25.008 = 0,•`0 <br /> .1.-. . <br /> ^'i <br /> cc? <br /> V1 <br /> ^O^ � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless the <br /> City of Everett from any and all claims for damages,costs,expenses,or <br /> 1 " causes of action that may arise because of installation and maintenance of the <br /> improvement or other right-of-way use hereto applied for and further agrees to <br /> Appr d for Construction Date remove same upon notice from the City and to replace public property <br /> Ho // /7`'Q�!`���� dam g d thereby. _ ' <br /> FINAL INSPE MION Date . ` I0 I0 I <br /> Approved as Constructed Sig ature ofApplicant !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 COMPLL I ION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />