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I <br /> rvcretl <br /> Q APPLICATION FOR RIGHT-GF-WAY USE PERMIT <br /> `j Type or print clearly with Ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS PERMIT NO._,1��0 <br /> EVERETT, WASHINGTON <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY — ----- <br /> HEREBY APPLIES FOR PERMISSION TO— <br /> AT THE FOLLOWING LOCATION <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> i <br /> I <br /> I <br /> 1 <br /> II <br /> I <br /> DRIVEWAY SEC TI )N <br /> PERMIT IS VALID FOR 60 DAYS {�-- — --� <br /> COPY OF THIS APPLICATION TC BE POSTED <br /> ON JOBSITE, II 30' ___ „30" <br /> CALL FOR INSPECTION 259-88 4 1 C' <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby sprees to hold and save harmless <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 rlghl-of-way use <br /> hereto applied for and further agrees to remove same upon notice <br /> from ^e CI'y and to replace public property damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICA1101,15 <br /> DRAINAGE TRAirIC / <br /> dA" <br /> WATER PLANNING 51GNATURE'r" CAN /f <br /> 4 o" Z/// <br /> STREET <br /> ADORES%� <br /> / <br /> 1-22 - <br /> 2 <br /> DATE cC r�NE <br /> p V FU NS RU ION pt 1ERNAlE <br /> IELEPNONE NUMBER <br /> ppP ps coNSTnucTEn DATE DATE <br /> CONSTRUCTION/AS BUILT _'Cr _ 1978 <br />