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� � <br />� i - . J� . � <br /> _ � , <br /> ���.�„ <br />'� � APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print cleady with mY <br /> PRESS HARD -YOU ARE MAKING COPIES <br />( PUBLIC WORKS PFRMIT NO. ��/ � <br /> EVERETT.WASHINGTON <br />� <br /> APPLICANT (UNDERSIGNED)hND FIRM REPRESENTED, IF/1NY: <br /> f HEREBY APPLIES FOR PERMISSION TO , <br />� AT THE FOLLOWING LOCATION � I I 7 I�J� JI F S� _ <br />� DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> t <br />� I <br /> I � <br /> I <br /> ORIVEWAY SECTION <br /> I PERMIT IS VALID FOR 60 DAYS l�— ----1 <br /> I <br /> COPY OF THIS APPLICATION TO BE POSTED ��i" up —�� <br />� ON JOBSITE. 30 -�-3o I <br /> CALL FOR 11�ISPECTION 259-881 1 �-� <br /> 24 HOURS BEFORE CONSTRUCTION The untlersigned owne� �emby agrees 10 hold antl seve harmless <br /> ihe City ol Everelt Irom any and all claims lor tlemages, costs. <br /> eMpenses.or causes ol aciion ihat may anse because o�instatlation <br /> and maintenance ol I�e improvement or otner ngn4obwey use <br /> herelo apPhea lor ana lurther agmes t0�emove same upG�i�oliCe <br />� Irom Ihe Cily antl to rep�ate Dubli� prope�ly OamagCtl thereby. <br /> DEPARTMENT APPROVALS <br /> I SEWER GOMMUNiCAPONS <br /> I <br /> ORAINRGE TRAFFlC �� <br />, WAiEN PLANNING S�GN4iUAE OF APPLICANi ��{• z���✓% <br /> //_ a �J' -���:-�, _ <br /> noo�+ess <br />� srnE�T �. j`� � <br /> i , y��. � n�'` I , /� �� ��) � . cirr � "� ' <br /> �� ��'✓v� �� l.J[_ l./ <br /> i <br /> A�f H70VED fOF ST CTION � � DniE ' �S�—�/C G. � <br /> I TEIEPHONE NUMpER Ai�ERNp�� I I <br /> �I � � <br /> 1 � � � t /'�i'�i' � �� � � <br /> APP V`D rtS CON ' U TED` �ArE , ontE �I <br /> CONSTRUCTION/ASBUILT �t�— 1978 <br />[i � _ �� . <br />