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' eve�rtl <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WOR�S <br />EVERETT,'JYqSHINGTON � 7CI / <br />PERMIT NO. � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF qNY:._ �O M EL C O -=A! C <br />HEREBY AppLIES FOR PERMISSION TO —ZNSTHI/ R ��0� C Oni [ RETI D R 1 V t <br />AT THE FOLLOWING LOCATION <br />92 <br />DRAWING (WORK Tb BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BC POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAiNAGE <br />WAT6R <br />SiREET <br />DEPARTMENT APPROVALS <br />COAIMIINICATiONS <br />iPr1FFlC <br />PLr1NNING <br />APPROVEDFORCONSTqUCTION oATE <br />APPROVED AS CONSTRUCTED OAiE <br />CONS7RUCTION/AS BUILT <br />1'c� o �/ud . <br />ORIVEWAY SECTION <br />I" LIP <br />�-3�'� �_ _l_3p'�1 <br />T <br />The un0ersigned owner hereby agrees lo holtl anJ save harmless <br />Ihe City ol Everett Irom any antl el: clnims lor tlamages. costs. <br />ezpenses, or ceusCs ol UC�ion �hai may anse betause ol insiallation <br />and maintenance ot Ihe improvemenl oi olhcr nghLol-way use <br />hcrelo appbetl lor antl lutlher agrees lo remove same upon no1¢e <br />Irom the Gty and lo replace public properly tlamagetl t�ereby. <br />�� ' /Yi 1�, � ..i.c.. <br />SIGNAt�qE 0 APPLI ,ANi <br />� X e2035 <br />r1DD�ESS <br />�vE�:t-7T� i82o3 <br />GTY Z�p <br />337- ��{�� <br />TELEPMONE NUMBCq q�iEqN�it <br />�1 �� 7�79 <br />D4TE 1 — <br />�cE — <br />1978 <br />