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1� Q//9000 <br /> cfcrE•R • <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly w nL <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS <br /> EVERETT.WASHINGTON J �j PERMIT NO. <br /> APPLICANT(UNDERSIGNED)AND FIRM REPRESENTED, IF ANY:._61'e ll" Z/, -W <br /> HEREBY APPLIES FOR PERMISSION TO <br /> AT THE FOLLOWING LOCATION 2�iS- �����S_E- �VBf�i/� • �a• i"20� <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 < 11" LIP <br /> ON JOBSITE. 301r �30'�J <br /> CALL FOR INSPECTION 259-881 1 <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby agrees to hold and gave barrels& <br /> me City of Eyereb from any and all clai t for damages• costs. <br /> espenses,or causes of action that may arise ueeause of mstallatmnj <br /> end maintenance of the Improvement or other righl-ol-way use <br /> hereto applied for and further agrees to remove same upon notice <br /> from the City and to replace puhllc property damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICALONS <br /> DRAINAGE TRAFFIC <br /> WATER PLANNING I AZURE OFA LIC <br /> Ts4,? /_9 Ami F <br /> STREET ADDRESS <br /> r <br /> //// !iii i <br /> CI <br /> C 1 <br /> AP V N RU �'� D ES ) !17' 76 D0[1 �S •S — �G�✓ <br /> TELEPHONE NUMBER ALTERNATE LAV <br /> 6 3-/74/ _ <br /> APP ASC NSTRUCTED DACE DATE <br /> CONSTRUCTION/AS BUILT LL — -- 1978 <br />