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PVPFPII <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 �q PERMIT NO. <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED, IF ANY:/� C ,/--«X�- <br /> HEREBY APPLIES FOR PERMISSION TO <br /> AT THE FOLLOWING LOCATION 2 r 7 G <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED; <br /> //ACCcSS 7-6 76 TIL S T Sr . SU BJ 5-C I T"O V/S/$/L/ 12' <br /> ^cu Ph'tiey 6Fk' TIF,I C -r6 R�F- `1J1 SEL > AFNJix1d0 <br /> �-6 <br /> DRIVEWAY SECTION <br /> i <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED I" LIP <br /> ON JOBSITE. <br /> CALL FOR INSPECTION 259-881 1 <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees to hold and save harmless <br /> the City of Everett from any and all claims for damages. costs, <br /> expenses.of causes of action that may arise because of installation <br /> and maintenance of the Improvement or other nghl-ol-Way use <br /> hereto Applied lot and further agrees to remove same upon notice <br /> DEPARTMENT APPROVALS from the City And to replace public property damaged thereby. <br /> SEWER COMMUNICATIONS <br /> DRAINAGE TRAFFIC <br /> VIER PLANNING SIGNATURE OF APPLICANT <br /> STREET ADDRESS -7 /ff, i- <br /> 13., <br /> CITY lip <br /> AFFFIVVEU kUR GUNSS u low <br /> TELEPHONE NUMBER ALTERNATE <br /> 3- 74 <br /> APPROVED AS CONSTRUCTED DATE DATE - � <br /> CONSTRUCTION/AS BUILT EE 1978 <br />