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PUBLIC WORKS PERMIT Date: 3/28/2011 <br /> City of Everett Public Works Department Public Works Permit#: PW1103-017 <br /> _ 3200 Cedar Street Building Permit#; <br /> Everett, WA 98201 <br /> (425) 257-8810 Planning Reference#: <br /> Public Works Fee$: $ 301.50 <br /> Other $: <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> NELSON PETROLIUM TIM SLOTTA <br /> PHONE: PHONE: 2064595775 <br /> TAX PARCEL ID# SITE ADDRESS: 2815 HIGLAND AVENUE <br /> DESCRIPTION OF PROPOSED WORK: <br /> OIL STOP VALVE/OIL WATER SEPARATOR <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. CONSTRUCT PER APPROVED PLAN. <br /> w <br /> 0 <br /> h <br /> 0 <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 /> J/ to remove same upon notice from the City and to replace <br /> A c vqd for Constru do Date public property amag d thereby. <br /> i,r <br /> _ I <br /> FINAL INSTIPdflOWDa <br /> Approved as Constructed Signture of Ap licant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PE IT IS ISSUED AND THEREAFTER 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 />