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r <br /> everetl <br /> Q 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. <br /> APPLICA IT(UNDERSIGNED) AND FIRM REPRESENTED, IF ANY. — <br /> HEREBY APPLIES FOR PERMISSION TO — — <br /> AT THE FOLLOWING LOCATION_ — <br /> DRAWING (WORK 1.0 BE DONE) OR THREE PLANS ATTACHED: <br /> C4nd'1 � �o\i`` -_;, <br /> 1• LX\�1TIvr1 *W (,nQ CSA, r1Gu MIP! QfC uw�n...nSf� - [.ry[l7�ct w..nSG <br /> c{U.le. �-p `J1•�-+G AL a%N3 f.V h.1tM.V�IOr y .%% M� ('tSlA 1f�.Y ui re\+.OVI� <br /> AX re fkace9 As AL" Pryy. 1 /��' L,•4�,.�-;0`..1 <br /> e7. I:N 1w` AfIJl wR�] ShO..(� Ip�. t,4' ,llles.0 �/.CavI Nt1W hO v.n 111` 1,L�/ I1 <br /> H!w G,f rJe w0.y -b �NJc � `tofIN9n�1(h% <br /> QT.L'e`Y l.a Cufb '1 ESN ttr'r' <br /> ye1J�� bc do�.. (1 , re.n..,J,.Q a»✓ rt Hate a 14) new <br /> Jr.0e why lor.�`).o.. 44-.001A e�r%,,Cn nl� lacvAtol ,, <br /> 3. �� Il eovl� revvlp ) a,�s V lW%v tat Saw - r,-k or 1 1 <br /> Owe+ � .�rGI,T PC� Been gVlS.oYr '�- <br /> 1 J <br /> L <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED I -LIP <br /> ON JOBSITE. I 3011 130" <br /> CALL FOR INSPECTION 259-861 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 /> e.pensesor causes of action that may arise because of Installation <br /> and maintenance of the Improvement or other Nghbol-way Ilse <br /> hereto applied for and further agrees to remove same upon nolrte <br /> from the City and to replace public property damaged thereby, <br /> DEPARTMENT APPROVAL:; <br /> SEWER COMMUNICA71ONS .,��� �j/ T !,✓ .�_��^ J� `J +�� CL-, <br /> DRAINAGE TRAFFIC <br /> WAtER PUNNING SIGNATURE Of APILICANT I -J / <br /> I <br /> STREET ADDRESS <br /> city IIP <br /> APPROVED FON CONSTRUCTION DATE -2 v/ f �, 4� I <br /> TELEPHONE NUMBER ALTERNATE <br /> <� ►7�- r <br /> APPROVE CONSiRV(,TEp DATE DATE <br /> INITIAL INSPECTION REQUESTED FEE — 1978 <br />