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glen APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with in <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED( AND FIRM REPRESENTED. IF ANY: / <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO B((E'' DONE) OR THREE PLANS +4CME4— <br />C Z\ t L\ w�1� ;s vLo% �oILI a.\ier-'Q <br />-. <br />1y11,(OW�..`a�G wore.. ll 1•\..�,.�1Fr�.Y � M..n.Gr <br />C�LC.1rL.n 100.� \ OJP.r.�(�,..+�'�+ � a,••�( �L..� <br />a <br />�afn �/7101e+�S <br />VerL-LL w, <br />v <br />�2 <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />�r'GcT`1 •may I <br />s •�V] <br />ASKr4:MCC- <br />DRIVEWAY SECTION <br />+I" LIP <br />L �3� <br />30'y_. <br />I <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages. costs. <br />expenses, or causes of action that may Anse because of Installation <br />and maintenance of the improvement or other right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />COMMUNICATIONS <br />SEWER <br />TRAFFIC <br />/ <br />/, t,�,� <br />/ 1. <br />DRAINAGE <br />�i,rf •_ <br />f I <br />. <br />9GNATURE OF APPLICANT �i <br />WATER <br />PLANNING <br />ADDRESS <br />STREET <br />!y <br />l <br />CITv <br />ZIP <br />2/40f <br />DAIE <br />as9/3�� <br />.355 <br />APFKUVtu lyinCONSTRUCTION <br />TELEPHONE NUMDEn <br />ALTERN TE <br />APPROVED AS CONS'iRUCTED <br />DATLL <br />ATE <br />t978 <br />INITIAL INSPECTION REQUESTED <br />FEE <br />