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I- everctl <br /> APPLICATION FOR RIGHT-OF—WAY USE PERMIT <br /> Type or print clearly with Ink <br /> PRESS HARD-YOU ARE MAKING COPIES <br /> PUBLIC WORKS / <br /> EVERETT.WASHINGTON p ����PERRMIT NO. <br /> APPLICANT tUNDERSIGNED)AND FIRM REPRESENTED, IF ANyY:f�1'7/.Naf�-F�- tom»_+- w�1rLf2Si, <br /> HEREBY APPLIES FOR PERMISSION To_-_—. <br /> AT THE FOLLOWING Lou. r ON Z y37i <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> I <br /> i <br /> I <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED <br /> ON JOBSITE. I LIP <br /> CALL FOR INSPECTION 259-8(31 1 �30'� -f�30", <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees to hold and save harmless <br /> the City of Everett F•m any and all claims for damages, costs, <br /> esponms.or causes of action that may arise because of Installation <br /> end maintenance of the improvement or other right-of-way use <br /> hereto applied for and further agrees to remove some upon notice <br /> from the City +nd to replace public property damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS <br /> DRAINAGE TRAFFIC <br /> �>> <br /> WATER 9 <br /> 55�� nn s� uu11 5511 AIIINING SIGNATURE OF APPLICANT <br /> TL 2 ?;? 3 ei <br /> STREET J � ADDRESS <br /> 'enr~ T� W/VI <br /> G <br /> hs)T � �" t CITY f G / ZIP <br /> P V O CON T fU I6N DAT 3S3 SI?3 3 _ <br /> TELEPHONE NUMBER ALTERNATE <br /> T ,i:lVl �10 YYTa(U�--� ATE <br /> A ED AS R SFU - T'~ D E GATE <br /> CONSTRUCTION/AS BUILT' EE - - 1978 <br />