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i <br /> everrl <br /> I 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 PERMIT NO -.�1 - 23 <br /> APPLICANT(UNDERSIGNED)AND FIRM REPRESENTED.IF ANY:_. _ <br /> HEREBY APPLIES FOR PERMISSION TO —..- - - - - - <br /> AT THE FOLLOWING LOf � v 1'7 2�4,,,QZ_ .14;) <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED SLIP <br /> ON JOBSITE. <br /> CALL FOR INSPECTION 25'9-881 1 ____ -4- <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. coats. <br /> R.penses,or causes of action that may arise because of Installation <br /> and maintenance of the Improvement or other nghrobwa, use <br /> hereto applied for and further agrees to remove 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 P SIGNATURE OF APPLICANT <br /> ria t5 yr <br /> ADDRESS <br /> J!/���/�i1Xn`�r/!/.�)✓O <br /> �OVECo,�� /�l 7 ��� CIT( ? , / • �/ zIP <br /> APYRVVt t r r DATE <br /> TELEPHONE NUMBER ALTERNATE <br /> APFUUEAS CONSTRUCTED ^ DATE DATES <br /> CONSTRUCTION/AS BUILT TEE 1978 <br /> �1���F�Y►iy��ll�:Y <br />