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ID <br />D <br />everen <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />VType or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY, / k <br />HEREBY APPLIES FOR PERMISSION TO n <br />AT THE FOLLOWING LOCATION LO� / Of f"" S(/1d r/ p} �D/ LZ�Mo <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />fcDA"porai j CLJnn� <br />9 <br />C311::' �v f an �tnk, ��voi b�fwRet� <br />O vv11lSTAtJ��T <br />w 1"tt+w_Q. hoa <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER COMMUNICATIONS <br />DRAINAGE TRAI TIC <br />WATER PLANNING <br />STREET <br />a S 932 <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages. costs. <br />espenses. or causes of action that may arise bpcauae of installation <br />end maintenance of the impro,,ement or other tight -of -way use <br />hereto applied for and further Lgrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />SIGNATURE OF APPUC r <br />A for - <br />I <br />ADORE; <br />2—V3 <br />CITI <br />Lr--z -12- <br />ZIP <br />3 s" 3 - Z 16CTELEPHONE <br />NUMBER <br />9/2- <br />�ALTERNATE <br />DATE <br />CONSTRUCTION/AS BUILT <br />1978 <br />