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PUBUIC WORKS PERMOT <br />City of Everett Public Works Department <br />3200 Cedar Street <br />y Everett, WA 98201 <br />(425) 257-8810 <br />OWNER NAME AND ADDRESS: <br />GIDDENS JACK <br />1520 80TH ST SW BLDG A <br />EVERETT WA 98203 <br />Date: 3/12/2015 <br />Public Works Permit #: PW1503-010 <br />Building Permit #; B1503-016 <br />Planning Reference #: <br />Public Works Fee $: $ 209.03 <br />Other $: <br />APPLICANT NAME AND ADDRESS: <br />PHONE: I PHONE: <br />TAX PARCEL ID # 00392200002301 1 SITE ADDRESS: 1520 80TH ST SW 4A <br />DESCRIPTION OF PROPOSED WORK: <br />RELOCATE WATERMAIN FOR BLDG ADDN- BLUESTREAK FINISHERS <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. Reroute water main as shown on the drawing. <br />r Ii <br />5. Maintain least 18- inches vertical se eration from other utilities sewer, drain. etc.. <br />70 <br />at <br />6. Provide mechanical joint restraint at all joints per City standard 5-13..._. <br />_ <br />7. Contact City of Everett Inspector Randy Allen 425-339-7403 <br />prior to starting construction. <br />r' <br />i i <br />-"J <br />: <br />Description C QTY Amount <br />^, <br />..........4....5.....a.. <br />.....P......,..R....K....I.P..I..G......L...O....T......P..r..'�..'.a.J..1..............................N.G <br />(4rn 111..5.............. <br />p.::� *� <br />.mot <br />.......... .............'..........................'..................................................................... <br />................................... ........ <br />�+ <br />.. �. _t <br />'rL: fl <br />r cw .uF H-• ram.'. <br />(.T , I'Tl . •. n <br />r„1 <br />I/..' <br />' <br />F 1 i PLKi 1 R D, I E ,9 (EST) 3 5 5�. C8 <br />;`: ` r' Ti <br />Y`? Ef•;k r'•..) f,7:,) <br />a o7 i i_, x':' r.a _r::. <br />FrgSITE INSPECTION (EST) 31 5 <br />-'� c.';i CO <br />p fo Con uc i n D to <br />INAL IN CTION Date <br />Approved as Constructed <br />cri <br />Y _: r•:ri <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 />po remove same upon notice from the City and to replace <br />blic property damaged thereby. <br />re of Applicant <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF YATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY <br />PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UP(5N ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />t W ) <br />