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I <br /> PUBLI"ORKS PERMIT Date: 1/20/2017 <br /> Public Works Permit#: PW1701-019 <br /> City of Everett Public Works Department <br /> 3200 Cedar Street Parent Permit#: <br /> Everett, WA 98201 Planning Reference#: <br /> (425) 257-8810 <br /> Public Works Fee $: $ 65.00 <br /> Other $: <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> FITZGERALD HAL D & DORIS ALL ABOUT CONCRETE LLC <br /> 3811 121ST PL SE 12015 MARINE DR <br /> EVERETT WA 98208 TULALIP WA 98271 <br /> PHONE: PHONE: 2062407507 <br /> TAX PARCEL ID# 28050500206500 SITE ADDRESS: 5527 BROADWAY <br /> INSTALL SIDE SEWER STUBS <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. Connect side sewers per City Standard #'s 601 through 604. Copy of Standards is n <br /> attached. <br /> oC�Cni <br /> .� 7 <br /> 5. Install erosion control measures as determined by the Public Works Inspector, such ~� _�a <br /> as silt fence, straw bales, swales, or erosion blankets. 0 T. <br /> 6. No dirt, mud, rocks, or debris to be tracked onto roadway. <br /> 7. Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior U1 <br /> to starting construction and with other inspection requests. See attached to request an s ;Uri <br /> 'Z <br /> inspection. ,' <br /> r-.7 Go •n <br /> Public Works Permit Fee Breakdown: <br /> Misc. Minor Permits..............................$25.00 <br /> PW Plan Review.......................................$20.00 O <br /> PW Site Inspection....................................$20.00 <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 /> causes of action that may arise because of installation and maintenance of the <br /> A e for Constru io Date improvement or other right-of-way use hereto applied for and further agrees to <br /> pP remove same upon notice from the City and to replace public property <br /> damaged thereby. <br /> INAL INSPKItTION Date <br /> Approved as Constructed Sig,6atj46 of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 18 DAY OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY <br /> PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY T CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br /> "6/l.�-� <br />