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� everetl i <br /> � APPLICATION FOR RIGHT-OF-WAY IISE PERMIT I <br /> Type or prin�clearly wilh mk <br /> `iS HARD - YOU ARE IdAKING COPIES ' <br /> iPUBLIC WORKS I <br /> EVERETT,WASHINGTON PERMIT NO..Q/�7 i <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESE�+ . D, IF ANY:_�J HA r� SF � � <br /> � <br /> HEREBY APPLIES FOR PERMISSION TO C �.�-1.0 r l � 70 ,D � i�J i( � tiJ i= I <br /> AT THE FOLLOWING LOCATION / O �� �n S � G A F.cJ.v _ <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> � <br /> I <br /> COtiDITIONS: <br /> Public Ser�ices Inspector must be contac[ed priur ta beginning any work, for <br /> examination of area vithin easement. <br /> AfAny inatallation of drain line and catch basinnpp�ifaaht is responeible to return <br /> area within eusement to original or better cond n. <br /> � <br /> Signa re of Applicant <br /> % <br /> ORIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS � � <br /> COPY OF THIS APPLICATION TO BE POSTED i" ��p <br /> � ON JOBSITE. � 30';,� �3� <br /> CALL FOR INSPECTION 259-881 1 <br /> 24 HOURS BEFORE CONSTRUCTION The untleisigned owner hereby egrees to hold end save harmless <br /> Ihe Ciry o! Everell Irom any entl nll tlxims lor aem�ges. cosls. <br /> eapenses,or couses ol aclion t�at m.ay Arise�eWuse ol�nstallalion <br /> and mainlennnce ol ihe improvemenl or other ng�bN xay use <br /> herelo apphe0 lor antl lurther agmes to remove same upu�•not¢e <br /> Iwm �he .:�ry an0 lo replace Oubhc pro0eny tlamagetl 1"are�y. <br /> DEPARTMENT APPROVALS <br /> 5[WEfi COMMUNICATIONS /" <br /> ORAINAGE iqAFFlC <br /> WATER P�ANNING ATUR[ P 1 <br /> �l� C..�(L'S�/L C/ ��� <br /> STqEET r1DDRE55 /y�/ <br /> y// ��I�.rrS� / 0 �� <br /> AP/OV�RC/'1cTTON S—/2A/g/ C1� � —7 � VJSP/ � (OJ�I/ <br /> �--D�TE � J / `lJ �G� <br /> TELEPMONE NUAIpER ALtERNATE <br /> 7�f ,KvG � ! (�/�o/ � <br /> AP ED AS CTED DaiE oAr � <br /> CONSTRUCTION/AS BUILT ,EE 1978 , <br />