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PUBLIC �RKS PERMIT �ateApplied: 12/12/2017 <br /> � City of Everett Public Works Department Public Works Permit#: PW1712-021 <br /> �� 3200 Cedar Street Parent Permit#: <br /> � Everett,WA 98201 Planning Reference#: <br /> ` (425)257-8810 Public Works Fee: $65.00 <br /> 15 D'EC° ��1� <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> TERRACON CHRISTIANSON BRIAN (TERRACON) <br /> 21905 64TH AVENUE WEST 21905 64TH AVENUE WEST <br /> MOUNTLAKE TERRACE, WA, 98043 MOUNTLAKE TERRACE, WA, 98043 <br /> PHONE: PHONE: 4257713304 <br /> TAX PARCEL ID#: 00581900002800 SITE ADDRESS: 4920 EVERGREEN WAY <br /> DESCRIPTION: DRILLING TEST BORINGS FOR EMERGENCY ROCKERY STABILIZATION <br /> & ROADWAY REPAIR IN GLACIER LANE RIGHT-OF-WAY. LOCATION ON EAST SIDE OF STREET. <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. Traffic Control must be done in accordance with MUTCD Standards and the Traffic Control Plan approved by City of <br /> Everett dated 12/12/2017. Use COE Std Dwg 703. <br /> 5. Any damage to City improvements (sidewalk, curb, roadway, etc.) shall be replaced per City Standards an�r as�;�„:; <br /> directed by the City PW Inspector. � , ��-_��--= �; �„�`"-�, <br /> 6. Street restoration must be done per COE Standard Drawing#326 and trench restoration p �#�6a14,:e��dir�'�ted°by the <br /> City PW Inspector. Permanent restoration must be completed within 2 weeks of completion o�tilit�wi�,4�Js�ike material <br /> for backfill of roadwa /shoulder. "''�' r.s:s'r'�'-�`'�� `=� <br /> Y ,..a <br /> 7. A minimum of 5ft separation between City of Everett utilities and directional boring/pavement cuts shall be�aintained. <br /> 8. Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior to starting constructic�iii, to;=�=;� <br /> evaluate traffic control set-up, with other inspection requests, and to final the permit. �•-'���•; <br /> 9. Coordinate with adjoining businesses/homeowners to minimize obstruction of commerce/access. '=�; <br /> �"� '-=a <br /> ���: <br /> Public Works Permit Fee Breakdown: i�;� �� <br /> ���� <br /> � •I;Iit d {-.F,t�l;i=P�EF:c <br /> Misc. Minor Permits................................................... 25.00 �� ,,-.. r�:���•�,;��.,� <br /> � �.�� ;;;., ,•�,.��_�,c_y��:; <br /> ��... <br /> PW Plan Review........................................................$20.00 � ������, �, ` a ��� . ��-a <br /> PW Site Inspection....................................................$20.00 � ,�;,� t� � �,�,4,�.->,-., ,. �� <br /> t._o ._�%�c-> "'� <br /> �-1;_'i C?7 <br /> Q�C i 5 �t��� {�,,,Y# �.; <br /> , �, ,_:.�. <br /> �, <br /> �ITY OF EV���°"�°'S <br /> Permit S�rvic�� <br /> City ofEve�e[t 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 /> l2 (2 (� expenses,or causes of action that may arise because of installation and <br /> 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 /> repla e public property damaged thereby. <br /> FINAL INSPECTION Date � ��� <br /> Approved as Constructed (PW Inspector) Signatu 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 PURSUED TO <br /> COMPLEfEION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90-DAY DURATION. <br />