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DyPT�n APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type of print clearly wilt' Ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS PERMIT NO. � - <br /> EVERETT,WASHINGTON <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY:�T <br /> HEREBY APPLIES FOR PERMISSION TO <br /> -- �-� �T <br /> AT THE FOLLOWING LOCATION _ <br /> DRAWING (WORK TO BE DONE) OTHREE PLANS ATTACHED: <br /> Rol <br /> Nr <br /> �° <br /> U <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAVS --- <br /> COPY OF THIS APPLICATION TO BE POSTED I" LIP <br /> ON JOBSITE. <br /> CALL FOR INSPECTION 259-981 1 <br /> 24 HOURS BEFORE CONSTRUCTION <br /> The undersigned owner herby and <br /> all la hold and cave damages,harmless <br /> COSTS <br /> Ino ase of EausR (rpm any end ell chime for sofinclcotle. <br /> flion <br /> and <br /> expenses.orof a improvement <br /> rhet may arise because t-f-wayuse <br /> and maintenance of the Impmremeni or other right-of-way use <br /> hereto applied lot and IWthel agrees to rempya Same upon notice <br /> from the City and to replace public property damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS <br /> DRAINAGE TRAFFIC <br /> WATER -- PLANNING .aIGNATURE Of APPIICANI <br /> �O /C3J Y .iC lv G <br /> __--- ADDRESS <br /> STREET F G �� FJ 1> <br /> CITY ZIP �•/ <br /> APPR VE FOR CONS iRU TION DATE _ , / -3 <br /> TELEPHONE NUMBER ALTERNATE <br /> 1�1 - 5 —11-;1y <br /> APPROVEOAS CONSTRUCTED DATE DATE <br /> CONSTRUCTION/AS BUILT FEE 1978 <br />