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EverlNt <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />VType or l it clearly with ink <br />PRESS HARD - YOU ARE MAKING rOPIES <br />PUBLIC WORKS �� y_ <br />EVERETT. WASHING —ON PERMIT NO. 3 r" <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: �u i'1 q, ✓b� G!r C' 1^-r C S tiC <br />HEREBY APPLIES FOR PERMISSION TO C rn. �1 I- L / U <br />AT THE FOLLOWING LOCATION '� L U / v r 1" V 0LL C C dL �•�N <br />DRAWING (WORK TO BE GONE) OR THREE PLANS ATTACHED: <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 />SEWER <br />DRAINAGE <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />PLANNING <br />STREET <br />PROVED FORD NST UCTION DATE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />LIP / I <br />_I_3-0J <br />The undersigned owner hereby agrees to hold and save harmless <br />me City of Everett from any and all claims for damages. costs. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the Improvement or other righbof-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby, <br />.. <br />�/��ri/ ✓""`-'I Vim/ <br />SIGNAT OF APPLI <br />u/3 <br />/v, 7 = �s— <br />ADDRESS <br />r1d'LO(� <br />X S 9 -/Gc / 2�•Gi FS __ <br />TELEPHONE N MBER ALTERNATE <br />// zC 79 <br />DATE <br />REFERENCE COPY FEE 1978 <br />