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�vE•reN <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly with Ink <br /> PUBLIC WORKS PRESS HARD- YOU ARE MAKING COPIES <br /> EVERETT.WASHINGTON PERMIT NO S 1.�3 Z <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br /> HEREBY APPLIES FOR PERMISSION <br /> AT THE FOLLOWING LOCATION -27�A', <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: / <br /> I <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED " LIP <br /> ON JOBSITE. �30' <br /> CALL FOR INSPECTION 259-881 1 L I 3011 <br /> 24 HOURS BEFORE CONSTRUCTION <br /> The undersign I owner hereby agrees to holo and save harmless <br /> the City of Evmalf from any and all claims for damages. costs, <br /> expenses,or causes of action that may ause because of installation <br /> and maintenance of the improvement or other nghhobway use <br /> hereto applied lot and further agrees to remove same upon notice <br /> DEPARTMENT APPROVALS from the City and to wd'ace public property damaged mereby. <br /> SEWER COMMUNiCA 11UNS <br /> DRAINAGE TRAFFIC <br /> WATER PLANNING - <br /> 51,NA}URE OI gPPL1GN1 <br /> STREET f/y ADURESS /� q <br /> a� <br /> APPROVED FR(, NS U I N 1 OA�E 46C7 7a ESS y ZIP <br /> Y (pppJ(/ TELEPNUNE NUMBER ALTERNATE <br /> A7rVJ AS CONS RUCTED VATE DATE <br /> CONSTRUCTION/AS BUILT ----- 1978 <br />