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r•CFCiT <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly With ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PU3LIC WORKS <br /> EVERETT.WASHINGTON PERMIT NO. <br /> APPLICANT (UNDERSIGNEDI AND FIRM REPRESENTED, IF ANY:---- <br /> -7— <br /> HEREDV APPLIES FOR PERMISSION TO �' rt4-�� V " <br /> AT THE FOLLOWING LOCATION_ 'j, Z 7 <br /> l O�d1L l V1. - - <br /> I,a e x�s� i� s etNQ�l 5 C -LA a-.,Q Gtfi <br /> LL <br /> . Q�� LA K �Q V✓�Q G P cY — G•n C1OL H,. 4C C �O rl C a y ' <br /> CA GO vl <br /> ttQQ �` <br /> Z,..�� �'=�n r-� •.s.�.3-w�coo•-. _ <br /> C) VIA -n' ewa� <br /> Q KlS'1 \\A, <br /> [ Ar rwecine �' �k�e.- w,L.E lar dA- 1�o e (I'eVKo��� <br /> QL.. c� ��4-Gem Q, �LA.II VIQ�'`WQ� �t{rt0 ctw� <br /> I: 1he� sLDet "4LKa i �g ll��1 all J�3+ w-' u <br /> oaAS Vn1A1. - <br /> AI.A-e,1 OL'A- ao " are. �- <br /> r—n ausfoL <br /> 1 DRN SEWAI� `6� TIUN <br /> PERMIT IS VALID FOR 60 DAYS _ <br /> f� <br /> COPY OF THIS APPLICATION TO BE POSTED (Ii' LIP <br /> ON JOBSITE. <br /> CALL FOR INSPECTION 259-881 1 1_30'"I �1 0 <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.penses.or causes of action that may arise because of Installation <br /> and maintenance of the improvement or other right-ol•Way Use <br /> hereto applied for and further agrees to remove same upon notice <br /> tram the City and to replace public properly damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER r,OMMUMo ATIONS / r <br /> DRAINAGE TRAFFIC <br /> WATER PLANNING SIGNATURE OF APDL .ANT/ g <br /> / S 3/�o -5-d `4- (_&-/ <br /> STRESS ADORES <br /> its <br /> CITY ZIP <br /> ASD FO N U I DATE y �4 <br /> TELEPrIONE NUMBER ALTERNATE <br /> PROVED AS CONSTRUCTED DATE DATE <br /> CONSTRUCTION/ASBUILT FEE 1978 <br />