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cvercU <br /> i <br /> ue <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Ty?e ul print clearly With rnk <br /> PRESS HARD - YOU ARE MAKING COPIES c91 - <br /> PUBLIC WORKS PERMIT NO. <br /> EVERETT.WASHINGTON --- <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED,IF ANY:��� llY(�t <br /> HEREBY APPLIES FOR PERMISSION TO <br /> 23273 - 80 <br /> AT THE FOLLOWING LOCATION_ <br /> ��' �• SE- <br /> IDRAWING (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 <br /> ON JOBSITE. 0" <br /> CALL FOR INSPECTION 259-601 1 <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner hereby sprees to holo end save harmless <br /> Ins City <br /> of Everolt IIOm any entl all claims for damages. cosB. <br /> cFpnsea.eor Cause.of action that may anse because of inslallellon <br /> and melnleruio. ul the Improvement or other right-ol-way use <br /> 03 <br /> sAme upon <br /> Nom the heosto pCity anrd to reDaceand futthe, aPublct Pro <br /> damaged Ins elhy. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICAI IONS <br /> TRAFFIC <br /> 0RAINAGE <br /> IGNATURE O PLICANI <br /> WATER — PIANNIN�-- r i i-•� <br /> ✓ ADDRESS <br /> STREET y(i r/ 11 /' <br /> —� CITY <br /> , N GATE -�_--- Al1ERNAIE <br /> A PRUVtU rwn..vl.b••�L-I�- TELEPHONE NUMOER <br /> 1 fIU6 a/ <br /> *, OVEC)AS OMS RUCTED�~ <br /> 0 E DALE <br /> CONSTRUCTION/AS BUILT rFE 1978 <br /> 978 <br />