Laserfiche WebLink
eve�etl <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />♦' Type ar print clearly with Ink <br />PRESS HARD - VOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON � PERMIT NO. �/- 9 <br />APPUCANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY:_(1��5' � rr�c.SvN � <br />HEREBY APPLIES FOR PERMISSION TO o�J �� RU CT S 1 tJC L F A M� LY _ <br />� <br />ATTNEFOLLOWINGLOCATION 3�i3 - r-c�c2A� ST E✓!/_ �r�,, /OZOI <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <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 CONST�,UCTION ' <br />SEWER <br />ORAINAGE <br />DEPARTMENT APPRCVALS <br />COMMUNICATIONS <br />TRAFFlC <br />PLFNNING <br />STqEET <br />�'/ �"(�'- riL� : — 6 <br />�P ED POR CONS7RUCr� N o�[rE <br />' � s �i�� l <br />APPFO CONSTqUC DArE <br />CONSTRUCTION/AS BUILT <br />�o'R/w <br />ORIVEWAY SECTION <br />� � <br />I" LIP <br />30'�f �30"� <br />i <br />7he untlersigned owner hereby ngrees lo holtl an7 save harmless <br />the City ol Everett Irom eny entl all cleims lor Oamages. costs, <br />expenses. or causes oi 6ction Ihat may arise becau9e of installabon <br />and mainlenance ol Ihe improvement or other rig�pol-way use <br />hmMo applietl lor an0 Iuri�er agrees b remove same upon nobce <br />IrOm Ihe City and tD replace Oublit properly damagetl Ihereby. <br />�l/� -�' <br />SIGNPT�E p( APPLICANT - � ' . ' �.� <br />t <br />lx � P��- /au c � <br />A�DRE55 '� .., - <br />f'� �f . rr- � � �4 � :,\ <br />CI^i�Y` ZIP <br />..? J i ' r J �I � \ <br />PNONENUMOER . �, ,• p�aERNpTE � <br />�� _���'I <br />onTe <br />197e <br />