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� � APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> I Type or pnnl cleeriy with Ink <br /> PFiCSS HARD - YOU �,RE MAKING COPIES <br /> IPUBUC WORKS o 3 � <br /> EVERETT,WASMINGTON PERMIT NO. <br /> APPLICANT (UNDERSIGNED) AND FIRM F�EPRE9ENT�D, IF ANY: ' -- <br /> HEFIEBY APPIIES FOR PERMISSION TO � ` — <br /> / . � . <br /> AT THE FOLLOWING LOCATION I�7�_3 A — D C • �S/` �i'i7c1' A V P -- � <br /> 1 <br /> DRAWING (WOP.K TO BE DONE) OR THREE PLANS ATTACHED: <br /> � <br /> P�, �.�� ���.tif,�-� w.� <br /> �.� i ��� � � - �y <br /> i <br /> i <br /> � <br /> � <br /> I ��� <br /> � <br /> � <br /> I DRIVEWAY SECTtON <br /> IPERMIT IS VALID FOR 60 DAYS � -----.� <br /> I . � ` l , � <br /> COPY OF THIS APPUCATIdN TO BE PO}STED� � i" �iP <br /> I ON JOBSITE. <br /> � 30" <br /> 30" I <br /> CALL FOR INSPECTION 259-881 1 � ' � <br /> I I <br /> I 24 HOURS BEFORE CONSTRUCTION � <br /> The un0ersigned owner �ere0y agrees to hold end save hermless � <br /> Ihe Ciiy ol Everelt Irom any nnd all claims lor dame9es, cosis. <br /> i , eepenses,or causes ol action Ihat may anse because ol in5lallaiion �� <br /> :,nd maimenance ol Ihe improveme�I or other ri9�I-oba�ay use I <br /> hereto�OP��etl lor antl lurlf�er agrees lo remove snme upon nolice i <br /> Irom Ibe City antl to replace public properly damagea Ihere�y. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNiCqiiONS /^�J. � I <br /> ORAINAGE TRAFFlG t�'��:��,G�� A � � '^—I— `_. <br /> � \.{1 �T/� _ I <br /> , _ _ <br /> i WATER PLANNING SIGNAiUR�O`APvIiCA i /��� <br /> �6 � �. ,��i.y <br /> I RODRE55 i <br /> STREET �.�J� . �� ���/ <br /> �� <br /> � � �` �r� o_ �' i S . , �, / <br /> �f'�/L / I ; .. . �CITY ' '� � 2iP <br /> I PROVEDFOfi 5T U T��N �ATE � S�� I/�v <br /> I <br /> � TELE�MON NUh10EA NLiENNAiE <br /> ' � � 27 /4UG P,a k 3/ :9 <br /> APPR E CONJ�R TED DATE �a�E ', <br /> � <br /> i CONSTRUCTION/AS �UILT �EE �978 <br />