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PUBLICAN/ORKS PERMIT III!HIiI Date Applied: 10/30/2017 <br /> City of Everett Public Works Department PubIIL UUorks Permit#: PW1710 043 <br /> 3200 Cedar Street Parent Permit#: <br /> Everett,WA 98201 Planning Reference#: <br /> (425)257-8810 Public Works Fee: $65 <br /> ,Ok <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> HOANG DUANA HOANG DUANA <br /> 3695 146TH ST SE 3695 146TH ST SE <br /> MILL CREEK, WA, 98012 MILL CREEK, WA, 98012 <br /> PHONE: PHONE: <br /> TAX PARCEL ID#: 00407800900100 SITE ADDRESS:4501 RUCKER AVE <br /> DESCRIPTION: PAVE EXISTING ACCESS TO GARAGE <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. Work to be done per reviewed site plans dated 11/01/2017. Plans must remain on job-site at all times. <br /> 5. Contact the City of Everett Public Works Inspector Randy Allen at 425-339-7403 prior to starting-co ructic forrA <br /> consultation, to evaluate Erosion/Sedimentation control set-up, and with all other inspection requests-, " <br /> n1 , <br /> 6. Keep City streets clean at all times. No dirt, mud, rocks, or debris to be tracked onto roadv -'r•,-17.2 <br /> Public Works Permit Fee Breakdown: f ; ; ;° <br /> Driveway $25.00 <br /> PW Plan Plan Review $20.00 rte} <br /> PW Site Inspection $20.00 ~? <br /> LT1 Tri <br /> '-. .r••} <br /> ,....Y }+.'�'Y Chi+""Y 11:11 <br /> +:.Y.,' i+^'> 1-Y <br /> 11.31 <br /> c.•a <br /> City of Everett Official Use Only ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save <br /> J t J harmless the City of Everett from any and all claims for damages,costs, <br /> i ✓( �-//-! 7 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 /> Ap ved for Construction (Public Works) Date for and further agrees to remove same upon notice from the City and to <br /> rep. - .. •c property damaged thereby. <br /> FINAL INSPECTION Date / i\ I UTI 1 " <br /> Approved as Constructed (PW Inspector) Sigi2ature of App i•.nt Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED n - ER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETEION.THIS PERMIT MAY BE CANCELLED BY THE CITY N ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90-DAY DURATION. <br />