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� J// / : J� <br /> epren <br /> � APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly wi�h Ink <br /> � PRESS HARD-- YOU ARE MAKING COPIES <br /> PUBLIC WORKS �n <br /> EVERETT,WASHINGTON PERMIT NO. J��— �yZ— _ <br /> APPUCANT (UNDERSIGNED)AND FIRM REPRESENTED, IF ANY: C, `Af IC S P � �10I �(0.TC� � ( • <br /> HEREBY APPLIES FOR PERMISSION TO �S � G X I S T I Y�) � D� � V � 'U�� U <br /> AT THE FOLLOWING LOCATION U �O Z 1"O 1Z�=�G� V Q\.) — _ <br /> DRAWISVG (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS � � <br /> COPY OF THIS APPLICATION TO BE POSTED i" �IP 1 <br /> ON JOBSITE. I _30" I � } 3o"_I . <br /> CALL FOR INSPECTION 259-881 1 I� `T' "—� <br /> 24 HOURS BEFORE CONSTRUCTION 7�e unEersignetl owner �ereby egrees to hold end seve harmless <br /> Ihe Ciry ol Everett Irom any and ell cleims lor tlama8es. costs. <br /> expenses,or ceuses of ection ihat may erise beceuse ol inslellation <br /> an0 maintenanc� ol the improvemenl or other right-ol-way usa <br /> hereio applied lor anA lur�her agrees�o remove Same upon nobte <br /> irom �he Cily antl to replace publ¢ proOe��Y DamageE Ihereby. <br /> DEPARTMENT APPROVALS <br /> �- - :�, � .- t <br /> SEWER � .' ' , , � � 'COMMUN4CA170N5 <br /> I _ � - � �' <br /> � <br /> OR�INAGE TRAFFIL � � <br /> f'+'' f -: . , <br /> WATER PLANNING SiGNATURE OF APo�ICFNT <br /> _........ .__..... _... _ _.. ... �1�1D Z t.OfeS t" <br /> T`i'�ii]•,iJ :i�` .`_ .'�- <br /> STFEET �•�DRE55 <br /> .3q��9 z>:to'sJ :;:i��<i E v �R E 5S i �a�. `�8��3 <br /> �i�Clu �CLdiT _ y�2n��/ ��•r :�° <br /> APPROVED F CO S R CTION oA 7 �g —32 7G <br /> • �ELE?��ONE NUMBEH A�iEFNATE <br /> L �- 1 S-- B I <br /> AP AS CONS UCTED AtE DATE <br /> CONSTRUCTION/AS BUILT FEE 7978 <br />