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J I <br /> i---- veren � <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT i <br /> I � Ty�e or print cleady with mk <br /> IPRESS HP 3D- YOU ARE MAKING COPIES II <br /> PUBLIC WORKS PERMIT NO. O �S <br /> EVERETT,WASHINGTON <br /> APPLICANT(UNDERSIGNED)AND FIRM REPRESENTED, IF ANY: <br /> U f/ /"I'(' T�.��C _.�'sr — f�,s i=.a/ _ '� r�i;F/�:� <br /> HEREBY APPLIES FOR PERMISSION TO � I <br /> i <br /> I ' I <br /> AT THE FOLLOWING CATION� n���� �L/� � / � � C�%/ �e <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> CONDITIO*IS <br /> That portion of the driveway within the right of way must be pav;d• <br /> f pc� <br /> Power of Attorney required. �� � � <br /> .�` ,� . �,� <br /> i . <br /> � <br /> I <br /> DRtVEWAY SECTION <br /> � PERMIT IS VALID FOR 60 DAYS I�-- --`i <br /> I <br /> COPY OF THIS APPLICATIUN TO BE POSTED �—�;" LIP , <br /> ON JOBSITE. �30"�—� �30" <br /> CALL FOR INSPECI'ION 259-881 1 <br /> 24 HOURS BEFORE CONSTRUCTION The un0ers:gneE owner hereby e9rees�o holtl end seve harmless <br /> the City ol Everetl Imm any and all claims lor dama9es. wsis. <br /> enpe�5es.or causes oi ection that may anse because ol m5taiiation I <br /> antl mamlena�ce ol t�e improvement or ol�er nght-o�-way use <br /> hereto appbed�or anE�urilier aq�ees to remove same uVon nohce <br /> Imm the City antl to ��olace pubbc O�operly aamageE I�ereby. I <br /> DEPARTMENT APPROVALS I <br /> SEWER ' COMMUNiCNT10N5 <br /> / ' � ' f <br /> I DRAINAGE TRAFFIO / / _ <br /> �-r� <br /> ✓ �� <br /> WATER / <br /> PLANNING IGN AE OF APP�I AM <br /> �� S �! �� -� F 1.6i1/ O I�� f�dlt�� I <br /> I v <br /> !.D AE55 <br /> STREEt �1 �'��r /,�� I ���� 0 � <br /> / / � <br /> �r1CIiV�__T ZIP <br /> ���'" .�,�-- 9/P/8o ��'S' ' S 6Y � � <br /> pPPi�VED NSTRUC110N ATE I <br /> TELEPHONE NUMBCR PL�ERN41E <br /> ' `�O 6 !J� — I <br /> VE AS STRUCTED o^TE oArE � <br /> CONSTRUCTION/AS BUILT «E 1978 <br />