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• r Fy <br /> :rest a <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly w,th Ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS <br /> EVERETT. WASHINGTON / PERMIT NO. <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF AN1t�.-+-AJ -�+�-A/� <br /> HEREBY APPLIES FOR PERMISSION TO_ �!' <br /> AT THE FOLI OWING LOCATIONi <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> 010 Is gdV <br /> L:, <br /> f- ,y <br /> DRIVEWAY SECTION <br /> I <br /> PERMIT IS VALID FOR 60 DAYS <br /> COPY OF THIS APPLICATION TO BE POSTED 1" LIP <br /> ON JOBSITE. Ir� <br /> CALL FOR INSPECTION 259-881 1 130 30" <br /> T' 1 <br /> 24 HOURS BEFORE CONSTHUCTION The undersigned owner hereby agrees to hold andsaveharmless <br /> the City of Everett from any and all claims for damages. code, <br /> expenses,or causes of action that may ante because of Installation <br /> and maintenance of the Improvement or other Dghl-of-way use <br /> hereto applied for and further agrees to remove same Upon notice <br /> from The City and to replace public property damaged Ihereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNIf ATMNS <br /> DRAINAGE TRAFFIC <br /> WATER PLANNING SIGNATURE OF APPLICANT <br /> / <br /> STREET ADDRESS <br /> cites :IP <br /> APPRUVEO RCONS RUG ION , DATE %YJ-3 — vf—y d'O <br /> -- / TELEPHONE NUMBER ALTERNATE <br /> -- - <br /> 4 - <br /> -8v � - IQv <br /> PROVED AS CONSTRUCTED DATE DATE <br /> CONSTRUCTION/AS BUILT IEE 1978 <br /> p—nva�T;r. <br />