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� PUBLIC�ORKS PERMIT Date: /17/2017 <br /> City of Everett Public Works Department Public Works Permit#: PW1702-032 <br /> 3200 Cedar Street Parent Permit#: C1701-026 <br /> Everett, WA 98201 Planning Reference#: <br /> (425)257-8810 <br /> Public Works Fee$: $ 65.00 <br /> Other$: <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> FISHER LOIS JEAN LARSEN SVEN <br /> 2110 PINE ST <br /> EVERETT WA 98201 <br /> PHONE: PHONE: 4254421350 <br /> TAX PARCEL ID# 00516444802700 SITE ADDRESS: 2110 PINE ST <br /> SITE WORK FOR NEW ADDITION <br /> This permit covers drainage for new addition and installation of splash blocks and dry well. <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 m —I PA <br /> • <br /> 4. Site Civil Work to be done per plans approved by the City of Everett Public WorlFs i•-°'--s-}--•i--- 1--1—!--- 4 °m.a a, <br /> Department dated 2/17/2017. en-._..,c„-r,-,:, :0, -n- , - <br /> - pr—rr- rn — :a: <br /> , : <br /> 5. Contact the City of Everett Public Works Inspector Randy Allen at 425-33 r40 ; P W <br /> 77, r•.� <br /> to starting construction and with other inspection requests. CO�: , <br /> 6. Install erosion control measures per City of Everett Standards for small parcels and <br /> 1-- <br /> ::'t �, H <br /> remove upon completion of the project prior to final approval of the permit. ., r•� ' ; •, <br /> CA <br /> 7. Keep City streets clean at all times. No dirt, mud, rocks, or debris to be tracked onto `'- r <br /> roadway. <br /> 8. Protect all existing underground utilities during construction. "..1 C <br /> 9. It is the applicant/owner's responsibility to ensure that stormwater runoff fromf"Yew <br /> impervious surfaces will be managed on-site in a manner that does not advers_ I a g: •.r. Ca c:'in r.y <br /> neighboring properties, including the City's right-of-way and/or easements ancE d ;- , ,2 , 7=,improvements located therein. �' '`'' `�' -' r-; <br /> Public Works Permit Fee Breakdown: Cr <br /> Misc. Minor Permits (Drainage Work) $25.00 O <br /> PW Plan Review $20.00 <br /> PW Site Inspection $20.00 a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> / The undersigned owner/applicant hereby agrees to hold and save harmless the <br /> �A City of Everett from any and all claims for damages,costs,expenses,or <br /> A� , / / / I ( C D 19- causes of action that may arise because of installation and maintenance of the <br /> Approved for Construction Date improvement or other right-of-way use hereto applied for and further agrees to <br /> remove same upon notice from the City and to replace public property <br /> damaged thereby. de- q-/-ccvvoca <br /> FINAL INSPECTION Date F.( ( <br /> Approved as ConstructedSignature of Applicant :337p2q17 - <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 DU TION.' <br />