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evereH <br />� <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO. 7J/r a <br />PUBLIC WORKS <br />EVERET?. WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPFESENTE�, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION d^ U �. � / / _ '-� � � � �� � • <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATl'ACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTEO <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />� <br />� <br />SEwER <br />DRAiKqGE <br />DEPARTMENT APPROVALS <br />COldMUNlCniION$ <br />1YATER ' ' PLANNING <br />STREET <br />APPROVED FOR CONSTRUCTIO�V UAtE <br />I I '_ . <br />lPPROVEDASCONSTRUCiED DniE <br />CONSTRUCI�I;�?1fi�.S I�IIILi" <br />DRIVEWAY SECTION <br />� j I" LIP <br />30" �� 3_0'� <br />The urdersigned owner �ereby aprees to hold an0 save harmless <br />the City ol Everett Irom any antl all claims for tlamages. cosls, <br />expense5. or Cauces ol eCiion Ihal may an5e beCausc ol ins�allaiion <br />antl ma�nlenance ol �he improvemeni or o��c� nghi-obway use <br />hC�C�O T�p1i20 lor �ntllurihe� agree5 lo reinove SamC opon noiice <br />Irom Ihe Cily antl Io replaCe pubhc proper�y damagetl Ihereby. <br />� � / / � <br />� <br />SIGNATU�E APP�IC1 1 <br />�3ah ��� `r � <br />AODf�E55 <br />G .7�v.tJwoa,7 l�/J. ���.3� <br />��,. Z�� <br />��� �/i s � <br />TELEP�N/ON[ NUM1�DE� q�1E�iNA1E <br />o,irE'� . - . — — <br />ree -- ------- 1978 <br />