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Pyerelt <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 1 <br /> EVERETT.WASHINGTON PERMIT NO. <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED, IF ANY. <br /> �� <br /> HEREBY APPLIES FOR PERMISSION TO "r"`�'• �� ' r-�"�-• �"�"� <br /> 2 I - <br /> AT THE FOLLOWING LOCATION 7 G. ''� S <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> RcGcSS Td 76 � -S Y S. Vj. SU 8,1 5-C 7-0 V/St"i T1' <br /> © U!U Po6NL'Y 6E P Tl FICA) i G - 6 SE PV 1 NEl t> " FFA//'lltlq <br /> RFCi ipJ' ot- Whggfik Ty 1��E.b �o R An f�r car? T- QF <br /> W�°Y fi��T1 76 z3y'sT S, u1, <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED <br /> ON JOBSITE. �3.0' _ _L 30" <br /> CALL FOR INSPECTION 255-881 1 <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees to hold and sere harmlaes <br /> the City of Everett 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 Improvement or other nghl-of-way use <br /> hereto applied lot and further agrees to remove same upon notice <br /> from the City find to replace public property damaged thereby. <br /> � DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS <br /> DRAINAGE TRAriIL �� r .Ic�1�`e�/L1/u•-•I I <br /> WATER PLANNING SIGNATURE OF APPLICANT <br /> i3—i7 iff3 • 5' <br /> STREET ADDRESS 1 <br /> /3, rf+ <br /> CITY pp/ IIP <br /> AEh J NSTRUWIUN V DIJE A <br /> TELEPHONE NUMBER ALTERNATE <br /> 3— is — Z9 _ <br /> APPROVED AS CONSTRUCTED DATE DATE <br /> • CONSTRUCTION/AS BUILT iEE 1978 <br />