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'UBLIAVORKS PERMIT <br />City of Everett Permit Services <br />3200 Cedar Street, 2"d Floor <br />Everett, WA 98201 <br />(425) 257-8810 <br />6 Date Applied: 1/14/2019 <br />Public Works Permit #: PW1901-027 <br />Associated Bldg Permit #: <br />Planning Reference #: <br />Public Works Fee: $65.00 <br />0 4 APR 201 <br />OWNER NAME AND ADDRESS: <br />APPLICANT NAME AND ADDRESS: <br />PROVIDENCE HEALTH & SERVICES-WASHINGTON <br />DAVID WACHOB, PRMC <br />1801 LIND AVE SW #9016 <br />RENTON, WA, 98057 <br />PHONE: <br />PHONE: 4254469122 <br />TAX PARCEL ID #: 29053000200100 <br />SITE ADDRESS: 916 PACIFIC AVE <br />DESCRIPTION: CONCRETE ISLANDS IN PARKING LOT <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 approved by the City of Everett Public Works Department dated 4/3/2019. Approved <br />plans must remain on job -site at all times. <br />5. Inspections are required for all stages of construction. Visit the City's Online Permitting Portal at pw.everettwa.gov to <br />formally request all required inspections. Flyers are provided at permit issuance with instructions on how to rec(iest:A <br />inspection online. -, <br />6. Install and maintain erosion control measures per City of Everett Standards and per the dims -off PW4 nspector. <br />Remove upon completion of the project prior to final approval of the permit. <br />7. Keep City streets clean at all times. No dirt, mud, rocks, or debris to be tracked onto roadway. ':', °> <br />8. Protect all existing underground utilities during construction. <br />9. It is the applicant/owner's responsibility to ensure that stormwater runoff from new/replaced impervious surfaces!iir% ;be . <br />managed on -site in a manner that does not adversely affect neighboring properties, including the City's right -of -wail aarfd/or <br />easements and the improvements located therein. <br />10. This permit must be finaled in order to close out this permit/grant a TeA#icate of Occupancy.; equest a final inspection <br />online by selecting PW-Site Final within the Online Permitting Portal Ine <br />p on is foli9 ermit when all item�iavebeen com leted. F <br />Public Works Permit Fee Breakdown: APR 0 4 /n/pf�fl/yf <br />OR <br />�r V 1 V <br />Misc. Minor Permits (Curb Island with Gate).......$25.00 <br />PW Plan Review..................................................$20.00 CITY <br />PW Site Inspection...............................................$20.00 <br />If <br />ices <br />APR 0 4 2010 <br />City of Everett Official Use Only OTr OWLEDGEMENT OF CONDITIONS <br />�TineeUo r/applicant hereby agrees to hold and save <br />el►i�lkE8!et%%Wverett from any and all claims for damages, costs, <br />�% rJerf� 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) bafe for and further agrees to remove same upon notice from the City and to <br />replace public property damaged thjjeby. <br />>f <br />� Ylu—7 <br />FINAL INSPECTION Date2 <br />Approved as Constructed (PW Inspector) 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 PURSUED TO <br />COMPLETEION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90-DAY DURATION. <br />R46- <br />