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� • - � SSrcS- <br /> r vrrrit <br /> Ue APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly with ma <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS <br /> EVERETT, WASHINGTON PERMIT NO. <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: ✓/ T' V' �E*l 1�f Sl _ <br /> HEREBY APPLIES FOR PERMISSION TO��e <br /> ��1— <br /> AT THE FOLLOWIN5 Lr;CATION__2y11 __90 -57E Evvrey5,`&14 99aa3 <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> 1 <br /> I <br /> i <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED I" LIP <br /> ON JOBSITE. 30" <br /> CALL FOR INSPECTVIN 259-861 1 <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees to hole and save harmless <br /> the City of Everett from any and all claims for damages. costs. <br /> e Fpensm•.or causes of action that may anti because of Installation <br /> and maintenance of the Improvement or other right-obway use <br /> hereto applied for and further agrees to•emove same upon notice <br /> DEPARTMENT APPROVALS from the City and to replace public properly damaged thereby, <br /> SEWER COMMUNICATIONS <br /> DRAINAGE TRAFFIC <br /> WAT PLANNING GNAtURE Of APPi <br /> 1 <br /> _ S—0.2 F Ave SC <br /> STREET ADDRESS <br /> CIT. ZIP <br /> q <br /> AP ROV CON PU T17H J Q T <br /> Y\ TFLEPHONE NUMBER ALTERNATE <br /> AFIPVVVV AS C0f9STRUCTED DATE DATE <br /> CONSTRUCTION/AS BUILT FEE 1978 <br />