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1 1 JUL 201i <br /> PUBLItIORKS PERMIT II III Date Applied: 4/28/2017 <br /> 41,17- <br /> wl Pub c-Works Permit#: PW1704-051 <br /> City of Everett Public Works Department <br /> 3200 Cedar Street Parent Permit#: <br /> Everett,WA 98201 Planning Reference#: <br /> -..:il' (425) 257-8810 Public Works Fee: $65 <br /> OWNER NAME AND ADDRESS: APPLICANT NAME AND ADDRESS: <br /> MAI THANH-TUNG T MAI THANH-TUNG T <br /> 4419 115TH ST SE 4419 115TH ST SE %" <br /> EVERETT, WA, 98208 EVERETT,WA, 98208' <br /> PHONE: PHONE: 4252240154 <br /> TAX PARCEL ID#: SITE ADDRESS: 10315 MERIDIAN AVE <br /> DESCRIPTION: CULVERT DITCH ALONGSIDE OF ROA►+WAY <br /> THIS WORK INCLUDES INSTALLING 38FT OF 12 INCH ''° 'IPE/THIS IS NOT A PERMIT FOR WIDENING THE <br /> DRIVEWAY I V <br /> THIS PERMIT TO BE OSTED 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 JM 811. <br /> // I—I-.-f-"' N d <br /> es <br /> 4 .The contractor must meet with the Public Works Inspector to discuss potential drainage rotc, egining the <br /> project. Call Jim Knappert at 425-339-7404. ; ,....4.7:4-:. ' <br /> 5. No dirt, mud, rocks, or debris to be tracked onto roadway. <br /> w m-•a <br /> 6. Any damage to the City Sidewalk or other improvements shall be replaced at the direction of the City Public Worle <br /> Inspector. ; <br /> 7. Work to be done as indicated on plan dated 04/28/17. (Copy attached) iy F; <br /> ,fir rtS.PSy ..: <br /> Public Works Permit Fee Breakdown: `'�' °" � '-` <br /> PW Plan Review $20.00 ' e;. <br /> ca r.. ..a <br /> —4ra - <br /> PW Site Inspection $20.00 '' <br /> Driveway $25.00 <br /> City of Everett Official Use Only ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save <br /> C ,/,',L, � <br /> /�� harmless the City of Everett from any and all claims for damages,costs, <br /> Z13cJ 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 /> Appro l d for Construction (Public Works) Date for and further agrees to remove same upon notice from the City and to <br /> replace public property damaged thereby. <br /> FINAL INSPECTION Date c � (, ' J/1 11 1/7 17 <br /> Approved as Constructed (PW Inspector) Signature of Applica i Dat <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 />