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<br /> PUBLIC �11VORKS PERMIT Date: 10/7/2015
<br /> Public�✓Vorks Permit#: PW1510-012
<br /> City of Everett Public Works Department
<br /> 3200 Cedar Street Buildinq Permit#; C1510-005
<br /> �� �� Everett, WA 98201
<br /> Planning Reference#:
<br /> (425) 257-8810
<br /> Public Works Fee $: $ 115.00
<br /> Other $:
<br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS:
<br /> LITOVCHENKO ALEX OWNER
<br /> 4933 GLENWOOD AVE
<br /> EVERETT �/�/q 98203-1636
<br /> PHONE: 4253441875 PHONE:
<br /> TAX PARCEL ID# 28040100200900 SITE ADDRESS: 5506 GLENWOOD AVE
<br /> PW FOR NEW SFR
<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 - �:.;;:;;
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<br /> 4. Connect side sewer per City Standard Dra �rr�#s CQ1 �through fiO4 �py af�t��d�rds���attacl��d � � ,� n w
<br /> 5. The contractor must meet with the Pubhc��
<br /> p,rks li����ctqt=;to ck#s�uss��t�tE�f k�r�ir'rage f'�uting p�ior to' ' h—�
<br /> beginning the project. Call Randy Allen at 425-33'9-740�. See attached to requ'est an inspecti��3� =� �= : �
<br /> 6. Install erosion control measures as determined by the Public Works Insp��or, such as silt fence, straw bale�, ,.., �
<br /> swales, or erosion blankets. = ' ' ; O
<br /> 7. It is the applicant/owner's responsibility to ensurE�.that storm water runoff frorrm new impervious surfaces will be M..�
<br /> managed on-site in a manner that does not adversely affect neighboring properties, including the City's Right-of-way ;;; Z
<br /> and improvements located therein. -' ' ..
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<br /> 8. No dirt, mud, rocks, or debris to be tracked o�ti'to:�oadway_. � =
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<br /> Public Works Permit Fee Breakdown: -`'"��� -y�`� °-" � � r � �-� � r�_a _
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<br /> ---PW plan review (EST) $2'0':d0 ' ` _ __� - _ . �:.:,, ,;-,,.:�, �-;�-_;,-. , ��
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<br /> ---PW Site inspection (EST) $20.00 ` '`� } O
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<br /> ---Erosion control (other) $50.00
<br /> ---Driveway/concrete Apron $25.00
<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 /> d f C rUC � Da to remove same upon notice from the City and to replace
<br /> � public property damaged thereby.
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<br /> L INSPECTIO Date /�%�` S'�� - l� l lG
<br /> Approved as Constructed Signature of Applicant 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 COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.
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