3200 35TH AVE NE 2018-01-02 MF Import

6a� -14-95 7 Application For ti PUBLIC WORKS PERMIT a 2 O O Print or Type Only o g g 14 M Co C.l 40 M M M Henry Bacon 2350 140th Ave NE Bellevue 98005. 649--4867 Owner M: Aing Address aEity IA — — 1. Burlington Env 955 Powell Ave SW Renton icant Mailing Public Works Permit • Bidb. Dept e Public Works Fee i Total Fee Leas APPL Fee Paid S Balance Due a Terry Cheatem Zip rnone Describe Proposed Work Excavate soil which is impacted by diesel fuel release. Estimate 200 yds for off —site treatment. Praject Address (if known) ith Ave NE Star L mininann isia Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hrs. in advance - phone 259.8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1.800-424.5555. 4.. I'o help truniture erosion, arty spoil piles must be covered with plastic sheeting or other impervious coveting staked to the ground or anchored with rocks or sandbags. 5. Berms, earthen or otherwise, should be constructed at the perimeter of excavated areas to prevent i site runoff from entering the excavations. 6. All applicable Department of Ecology rules and regulation must be foflowed. i; As pw ��✓,+, �� lamer �ati£� z//3�yS ___L'ILet��i% z/Z3/�r5 Approved fo[Construction Date FINAL TNS CTION Date Approved as ConstrLLted PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of E,iarett from any and all claims for damages, costs, expenses, or causes of action that may arise because of instPiiation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the City and tj replace public property damaged thereby. gnature of Applicant Date 'WORK AUTHORII`cD BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.