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•r r � I <br /> :verett <br /> APPLICATION FOR RriGHT-OF-WAY CASE PERMIT <br /> Typo Or Pnlll ClenrlY will mh <br /> iPRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS <br /> $ <br /> EVERETT,WASHINGTON / PERMIT 140.79/-924 <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED, IF ANY: .GLe-�•t<f/J �`4 <br /> HEREB APPLIES FOR PERMISSION TO <br /> V <br /> AT THE FOLLOWING LOCATION- 301 `�RC D <br /> 7--~ r /e Wit <br /> "+ — <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> �` (S•,nw Cc,L.��-tiJC LYy. /�-J ��" Q"� Ls�"�' /k^•`-'-v�' •�,. C+.t,�.�/,�e <br /> i <br /> I <br /> I <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS -i <br /> COPY OF THIS APPLICATION TO BE POSTED <br /> ON JOBSITE. IL <br /> CALL FOR INSPECTION 259-881 1 <br /> 24 HOURS BEFORE CONSTRICTION The undersigned owner hereby agrees to hold and save harmless <br /> the City of Everett from any and i claims for damages. costs, <br /> expenses.or causes of action that nray arise because of Installation <br /> end maintenance of the Improvement OF other right-OF-Way use <br /> hereto applied to, arc i---ilmr agrees to remove tame upon notice <br /> from the City and to i<place public property damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS <br /> DRAINAOE <br /> --- TRAFFIC O�- • A ��-�- <br /> WATER --- FUNNING SIGNATURE OF APPLICANT' <br /> — ADDRESS DDRESS <br /> O <br /> .. IL f" y — 1 9 GITv ZIP <br /> 5V€H U FON DATE mro`- �o�o <br /> y TELEPHONE HUMBER AI TERNATE <br /> VED CONSTRUCTTED /1 57FU CONSTRUCTION/AS BUILT ,IF 1978 <br />