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P <br /> evetefl <br /> Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> VTypo or print clearly with Ink <br /> PRESS HARD- YOU ARE MAKING COPIES <br /> PUBLIC WORKS <br /> EVERETT.WASHINGTON /1// /{ PERMIT NO. 1/1/7 <br /> APAPPLICANT (UNDERSIGNED)AND FIRM REPRESENTED,IF ANY: /Gm /I w/ )/ <br /> HEREBY APPLIES FOR PERMISSION TO. .j _ 41L)�-V-oj <br /> / <br /> AT THE FOLLOWING LOCATION ,&; `o F/Ij-0J co"A <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> /luhae'. Al eaeltS <br /> !./d.t.'C144t /01-41111577.'• $,0`41" <br /> i <br /> I, <br /> I <br /> 1 <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED <br /> (I" LIP <br /> ON JOBSITE. I <br /> CALL FOR INSPECTION 259-881 1 h30•T' 'f'30� <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees to hold and save harmless <br /> I the CITY of E"nall 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 Implovemenl or other rlghhol-Way use <br /> hereto applied for and further agrees to remove same upon notice <br /> DEPARTMENT APPROVALS from the City and to replace public properly damaged thereby. <br /> SEWER COMMUNIC ATIDNS <br /> DRAMAGE --- TRAFFIC <br /> WATEO PLANNING NATURE OF APPLICANT <br /> STREET ACILH•(.r _ Ar/DES376 %/ <br /> vi ?fIli /Q / <br /> Si�c. <br /> "ADy'eV6 <br /> , �/ p <br /> A RtU TUFT CON5TRUGN DATE TELE <br /> IELEPHO NUMBER / ALTERNATE <br /> T`- --- - <br /> APPROVED AS CONSTRUCTED DATE DATE I <br /> rr.717RF�Ir7 C-Py rut - <br /> r <br /> I <br />