Laserfiche WebLink
APPLICATION FOR RIGHT--OF-WAY USE PERMIT <br />Type or print Clearly with ink <br />do <br />PRESS HARD • YOU ARE MAKINQ COPIES <br />PUBLIC WORKS •� PERMIT NO. _ _?U A3 <br />EVERETT. WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF AN'r - <br />HEPERY APPLIES FOR PERMISE ON TO <br />AT THE FOLLOWING LOCATION <br />O G r�T: <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />CONDITIONS <br />That potion of the driveway within the right of way <br />must be paved. <br />No vehiA a parking on 112th will be allowed during <br />construction. <br />Power of Attorney required. Cb <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-661 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />- <br />PLANNING <br />�/2d�P/ <br />PPfOU a DA}fA� CO 5 1 TE � f <br />CONSTRUCTION/AS BUILT <br />r <br />DRIVEWAY SECTION <br />L30" <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all clablla for damagescosts. <br />espenaes. or causes of action that may Strait because OI installation <br />and maintenance of the Improvement or other right-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />from pM City and to replace public property damaged ll'i. <br />—•-f I vVl �// vl <br />SIGNATURE OF APPLICANT <br />/06,00s 3yE' Di• s,b <br />ADDRESS <br />Evrr!{•� wrl 4e�o�/ <br />CITY z'P <br />3 37— 94'7 <br />TELEPHONE NUMBER ALTERNATE <br />q- d� - 00 _ <br />DATE <br />