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24 AUG 2017 <br /> PUBLIC mORKS PERMIT I ate Applied: 6/13/2017 <br /> City of Everett Public Works Department <br /> PublictlVUrks Permit#: PW1706-012 <br /> 3200 Cedar Street Parent Permit#: B1705-065 <br /> Planning Everett,WA 98201 Reference#: REVII17-013 <br /> (425) 257-8810 Public Works Fee: $85.00 <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> COMMUNITY HEALTH CNTR OF SNOH CO J R ABBOTT CONSTRUCTION INC <br /> 8609 EVERGREEN WAY 3408 1ST AVE S#101 <br /> EVERETT, WA, 98208 SEATTLE, WA, 98134 <br /> PHONE: 4257893700 PHONE: 2064678500 <br /> TAX PARCEL ID#: 00582202200101 SITE ADDRESS: 4201 RUCKER AVE <br /> DESCRIPTION: PATCHWORK PAVING IN PARKING LOT FOR TI <br /> Site work to include demolition of one driveway, partial sidewalk, and some landscaping. New site work to include partial new <br /> sidewalk, some parking re-striping, and relocation of existing generator pad. <br /> THIS PERMIT TO BE POSTED ON JOB SITE AT ALL TIMES <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 for Development'. <br /> 3. Call Location Underground Service 48 hours before you dig. The day you call does not count. TOLL FREE NUMBER 811. <br /> 4. Site Civil Work to be done per plans and drainage report approved by the City of Everett Public Works Department dated <br /> 7/28/2017. Approved plans must remain on job-site at all times. - r <br /> 5. Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior to starting,,,pp j§tructh tole by a <br /> pre-construction consultation. All inspections must be formally requested. See the attached handout ts?.Requa#s an. <br /> Inspection form for phone number and online instructions. C 1--" :re: <br /> 6. Install and maintain erosion control measures per City of Everett Standards and approveF-i <br /> d lanH Ove on <br /> completion of the project prior to final approval of the permit. 0-. <br /> 7. Keep City streets clean at all times. No dirt, mud, rocks, or debris to be tracked onto roadway. r,;) r9, 7 <br /> 8. As-builts of any installed utilities will be required to be submitted to the PW Inspector per City Design and Constr, f].4n <br /> Standards and Specifications for Development prior to final approval/close out of the permit. <br /> 9. This permit must be finaled in order to close out this permit/grant a Certificate of Occupancy. Sell the inspection lino <br /> request a Final for this permit when all items have been completed. CO :' <br /> Public Works Permit Fee Breakdown: „r'0 p A'pl <br /> Paving $45.00 .,;F-28 <br /> 8 <br /> PW Plan Review $20.00 "'=;r.-.1 <br /> PW Site Inspection $20.00 p-• <br /> City ofEverett Official Use Only ACKNOWLEDGEMENT OF CONDITIONS <br /> / The undersigned owner/applicant hereby agrees to hold and save <br /> harmless the City of Everett from any and all claims for damages,costs, <br /> ��� �-2& 2Z f7 expenses,or causes of action that may arise because of installation and <br /> ix,. maintenance of the improvement or other right-of-way use here to applied <br /> Approved for Construction (Public Works) Date for and further agrees to remove same upon notice from the City and to <br /> replac lic property aged thereby. <br /> FINAL INSPECTION Date ti <br /> Approved as Constructed (PW Inspector) Si atu 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 PURSUED TO <br /> COMPLETEION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ONrSTHIS PROJECT OVER 90-DAY DURATION. <br />