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Date 10-2-92 �d 2� — ' " Sf' `S� <br />Appiication For <br />PUBLI� WORKS PERMIT <br />Print or Type Only <br />Snohomish County <br />Owner <br />Applicanl <br />Pu01ic Wor�� Perm�t � —��L/�l(/ Z'\ <br />Blop. Dso�. • <br />PuEl�c Worb Fee <br />Tolel Fee � __ — � <br />Lata 1�ni Fee PeM i__ — <br />e�i�nc Due i N�C <br />3000 Rockefeller Ave M/S 303 Everett 96201 388-6614 <br />Mailing Address City Zip Phone <br />MailingAddress City Zip Phone <br />Describe Proposed Work construction/inatall bridg � accr,�$8 to Spencer Island. <br />Tax parcel 162905-1. 001. 0001 <br />ProjeCt Address (il known) <br />unioa <br />Attach four (4) copias ol plans lor propoaed work - Draw to scale and note the following as apPlicable: <br />• Property Lines • Centerline of street <br />• Outiine and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any omposed qrading changes <br />• Existing and proposed ulilities • Show measurements <br />PERMIT Ci?NDITIONS <br />1. All calls h�r inspectio.i shell be mede 24 hrs. in advance • phone 259�8810. <br />2. All work s�.all be peAurmed in accordance with this permit and current City of Everett Design and Constructlon <br />Standards and Specifications. <br />3. Call Lxation Underground Service 4B hrs. before you dip. TOLL FREE NUMBER 1•800�424•5555. <br />4. Snohomish County responsible for conatruction and operation and <br />main[enance of Uridge. <br />�V PUBLIC WOFKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�BB10 <br />W <br />� <br />—/ <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONCITIONS <br />The unde�signed owner/applican� hereby agrees to ho�d and save harm� <br />less the Cily ol Everett Irom any and all claims lor damages. costs. <br />expenses, or causes ol action thal may arise+ because of installation <br />and maintenance of the improvement or other right-ol-way use hereto <br />applied for and turther agrees to remm�e same upon notice iwm the <br />City and to replace public property damaged thereby. <br />SignaU:re of Applicanl Date <br />WOR�, AUTHORIZED BY THIS PERMI�f MUST BE STARTED WITHIN <br />78C DAYS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TG <br />BE DILIGENT�Y PURSUED TO COKiPLETION. THIS PERMIT MAV BE <br />CAiVCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PR(?JECT OVER �JO DAYS DURATION. <br />