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22 0 JUN 2017 <br /> PUBLIC WORKS PERMIT Date: 4/17/2017 <br /> { Public Works Permit#: PW1704-025 <br /> City of Everett Public Works Department <br /> m,: -t,,; r, . 3200 Cedar Street Parent Permit#: <br /> Everett, WA 98201 Planning Reference#: <br /> (425) 257-8810 <br /> Public Works Fee$: $ 197.50 <br /> Other$: <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> WESTERN WASH SEVENTH-DAY ADVENTISTS MCMULLIN STEVE <br /> 32229 WEYERHAEUSER WAY S <br /> FEDERAL WAY WA 98001-9347 <br /> PHONE: PHONE: 4252101909 <br /> TAX PARCEL ID# 00593700500002 SITE ADDRESS: 4132 FEDERAL AVE <br /> RE-STRIPING NEW ASPHALT IN PARKING LOT AND DRIVEWAY <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. As per approved plan dated 6-19-2017. <br /> 5. Keep City streets clean at all times. No dirt, mud, rocks, or debris to be tracked onto w <br /> roadway. <br /> 6. Provide any necessary Erosion control for this project as directed by the City Public <br /> Works Inspector. H <br /> 7. Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior <br /> to starting construction and with all other inspection requests. See attached to request <br /> an inspection. O <br /> 4 <br /> Public Works Permit Fee Breakdown: <br /> Parking Lot Paving $157.50 <br /> PW Plan Review $20.00 [s0l <br /> p <br /> PW Site Inspection $20.00 <br /> JUN 2 0 2017CA <br /> C <br /> CITY O4. <br /> F EVERETT <br /> Pern�ii 5eivice; <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless the <br /> ' \UL...._ City of Everett from any and all claims for damages,costs,expenses,or <br /> C/ ' lit-- n- causes of action that may arise because of installation and maintenance of the <br /> gla <br /> improvement or other right-of-way use hereto applied for and further agrees to <br /> 4proved for Construction Date remove same upon notice from the City and to replace public property <br /> da ,Jed thereb . <br /> FINAL INSPECTION Date I1 e. //` ( —2-O--I, <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 THEREAFTER 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 />