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ever N1 <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> J fype or print clearly with Ink <br /> PRESS HARD- YOU ARE MAKING COPIES <br /> PUBLIC WORKS <br /> EVERETT,WASHINGTON (/(JPERMIT NO. <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED.IF ANY: !lI ems/ <br /> HEREBY APPLIES FOR PERMISSION TO_ 'E•� <br /> G C;'A.J <br /> AT THE FOLLOWUIG LOCATION_- <br /> DRAWING (WORK TO BE DONE) OR THREE. PLANS ATTACHED: <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS � <br /> COPY OF THIS APPLICATION TO BE POSTED ___tI" LIP - � <br /> ON JOBSITE. 1—T– <br /> CALL FOR INSPECTION 259-681 1 x- 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 lot damages. costs. <br /> e.peness.or causes of cellon that may arise because of Inslellatmn <br /> and maintenance of the improvement cr other nghl-Of-way use <br /> herolo applied for and further agrees to remove same upon notice <br /> Iron the CIT., and In replace public propniy damaged thereby. <br /> DEPARTMENT APPROVALS i <br /> SEWER COMMUNICATIONS <br /> DRAINAGE TRAFFIC <br /> WATER PIANNINO SIGNATURE OF APPLICANT <br /> a 9-2 / , _ -✓ <br /> STREET <br /> ADDRESS �- <br /> Cnr YIP <br /> VE F C SRU IN OAF�Lr 3S3 � �AycP'y <br /> TELEPHONE,TNUMBER9 ALTERNATE <br /> Qa- <br /> �f-1 a - - 7 9 <br /> APPROVED AS CONSTRUCTE DATE DATE <br /> CONSTRUCTION/AS BUILT FEE 1978 <br />