4512 FOREST DR CINGULAR WIRELESS ANTENNA 2018-01-18

�� _ PUBLI�ORKS PERMIT � DateApplied: 3/30/2017 City of Everett Public Works Department Public Works Permit#: PW1703-074 3200 Cedar Street Parent Permit#: B1610-047 Everett, WA 98201 Planning Reference#: SPU16-011 -� � �"-��'�� (425) 257-8810 Public Works Fee: $65 OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: OUR SAVIOR'S LUTHERN CHURCH OF 4512 FOREST DR EVERETT, WA, 98203-2049 PHONE: PHONE: [AppPhone] TAX PARCEL ID #: 00449400201000 SITE ADDRESS: 4512 FOREST DR DESCRIPTION: REMOVE EXISTING 52'-5" UTILITY POLE/ANTENNA WITH 70' POLE PUBLIC WORKS PERMIT COVERS TRENCHING AND GROUND RESTORATION, AS APPLICABLE. FOREST PARK ADD TO EVERETT BLK 002 D-00 - BLK 2 LOTS 10-11 LESS PTN DEEDED CITY THIS PERMIT TO BE POSTED ON JOB SITE AT ALL TIMES PERMIT CONDITIONS: 1. All calls for inspection shall be made 24 hours in advance. 2. All work shall be performed in accordance with the permit and current City of Everett 'Design and Construction Standards and Specifications for Development'. 3. Call Location Underground Service 48 hours before you dig. The day you call does not count. TOLL FREE NUMBER 811. 4. Site Civil Work to be done per plans approved (as noted) by the City of Everett Public Works Department dated 3/30/2017. 5. Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior to starting construction and with other inspection requests. 6. Install erosion control measures per City of Everett Standards for small parcels and remove upon completion of the project prior to final approval of the permit. 7. Keep City streets clean at all times. No dirt, mud, rocks, or debris to be tracked onto roadway. 8. Protect all existing underground utilities during construction. See conditional notes on plans sheet A-1.0. 9. Any broken or damaged roadway/ public right-of-way shall be repaired/ replaced in accordance with current City of Everett Standards and per the direction of the City Public Works Inspector. 10. The face of the new utility pole shall be placed at least 2 feet behind the edge of the adjacent pavement. 11. All conditions of SEPA16-040 and SPU16-011 must be met prior to final of permit by the Public Works Inspector. 12. A separate Traffic Street Use Permit must be obtained prior to any interruptions to Forest Dr and/or the local street network surrounding the project area. This will require a custom traffic control plan. Forest Dr is a narrow roadway that provides the only access to several homes north of the project site. If For=.est D�will be obstructed for more than 15 minutes at a time during this project, each neighbor impacted by the closure shall`be contacted to discuss t�ow to minimize road closure impacts. Contact Traffic Engineering at 425-257-8810, Press Option 7. ' !,. ,� ' � , .; , Public Works Permit Fee Breakdown: ;� � � � r��+�" � _.��;� Misc. Minor Permits (Trenching/Restoration).......$25.00 _ '� ° ; ;...,. , . ._ �,„. PWPlan Review...................................................$20.00 ` `:' ?;"°:� � ,,;r��--�- : �- _ :;,, �� PW Site Inspection................................................$20.00 ;: _ :,,, . _ City ofEve�ett O�cial Use Only ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless the City of Everett from any and all claims for damages, costs, 3 30 201� expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of-way use here to applied Approved far Constructiop.�.PublicalVorks) Date for and further agrees to remove same upon notice from the City and to � � ` ' r lace public property damaged thereby. -� � �� /�- �'-/ � �- �--I - � � �� NAL INSPE � ON Date Approved as�onstructed (PW Inspector) i nature o Applic t Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETEION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90-DAY DURATION. F��