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PIJBLIC:�-�11012KS PERMI°r Date: 12/1/2016 <br /> Pubiic Works Permit#: PW1612-002 <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: APPLICAIJT NAME AND ADDRESS: <br /> ZINKOV TATYANA ZINKOV TATYANA <br /> 5621 SEAHURST AVE 5621 SEAHURST AVE <br /> EVERETT �/�/q 98203 EVERETT WA 98203 <br /> PHONE: PHONE: 4253462092 <br /> TAX PARCEL ID# SITE ADDRESS: 5621 SEAHURST AVE <br /> LEVEL RIGHT-OF-WAY AREA AND GRAVEL <br /> APPLICANT IS RECONSTRUCTING BLOCK WALL IN CONJUNCTION WITH THIS WORK. BLOCK WALL WORK IS <br /> UNDER 4 FT TALL AND DOES NOT REQUIRE A PERMIT. <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 �;�� ,.r;�.=; <br /> ,_; <br /> , <br /> . .. �. . <br /> ,..._._,..,.. :... ,: , <br /> ;_.__, ,:,� <br /> 4. Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior ;,,„i :::::: ;._{ � � r_,' w <br /> to starting construction and with other inspection requests. See attached to request an �; ;:T;,.�...�,:,.:, !` <br /> inspection. � " �- ��-' ;:-.:,: ["'� <br /> i''_„ .:. ,.. <br /> ,., M...� <br /> 5. Install erosion control measures as determined by the Public Works Inspector, such � � j;';���� <br /> as silt fence, straw bales, swales, or erosion blankets. � ' <br /> `!,,� <br /> 6. No dirt, mud, rocks, or debris to be tracked onto roadway. '�} '.:�0 <br /> ��_;• :; <br /> ��; �:.:�� <br /> 7. Gravel shall be installed so as not to kick out onto the existin street. This ma re uire ;�'����� ���'� <br /> �FJ�3'H:t.if:t� <br /> 9 Y q r•.�r•��r;;..� <br /> the installation of a paved shoulder along the street. Review this with the Public Works = ''�-'n�'��'�`' <br /> _,,��,,;_��_� _� 5 <br /> ,'.`��,:_ ,�, ' <br /> Inspector. � � �-��:_��T� <br /> ---+�a= � -= <br /> „�� �,_._,. -.::� <br /> � "- � <br /> Public Works Permit Fee Breakdown: O <br /> PW Plan Review..............�20.00 � � )'J <br /> PW Site Inspection..........$20.00 � ' '�'� RQ��9�� � � � <br /> Minor PW permit..............$25.00 <br /> F�. � <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 /> improvement or other right-of-way use hereto applied for and further agrees to <br /> Approved for Construction Date remove same upon notice from the City and to replace public property <br /> � / � � i/ � damaged ereby. <br /> -ZfL ����--_ ��- ' <br /> FINA INSPECTION Date `�� I l � �j l '�` <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 THEREAFfER 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 />