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• t <br /> a <br /> LAPPLICATION FOR RICHT-OF-WAY USE PERMIT <br /> Type or print clearly with Ink <br /> PRL'SS HARD- YOU ARE MAKINO COPIES <br /> PUBLIC WORKS PEHMIT NO. '79/.2 4 rj <br /> EVERETT,WASHINGTON <br /> APPLICANT)UNDERSIGNED)AND FIRM REPRESENTED,IF ANY ;_'. .a v.lte L' - - - - - - --- <br /> HEREBY APPLIES FOR PERMISSION TO <br /> J M-11 <br /> GOi./��-T� 7 5 t-T Lit..—•P 80 <br /> ( <br /> AT THE FOLLOWING LOCATION _ - 3 y. 1I- O-o i>( - N r -- <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> 'Ctt';-"C'k dr P"t-c .,-4 <br /> >Ly(,1� o--Lr,�•Mrcc�-c�Pi <br /> I <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS {�— <br /> CQPY OF THIS APPLICATION TO BE POSTED I" LIP —� <br /> ON JOBSITE. 3011 30" <br /> CALL FOR INSPECTION 259-881 1 <br /> 24 HOURS BEFORE CONSTRUCTION The undersigned owner heroby agrees to hold and save harmless <br /> The City of Everett from any and all claims for damages, costs. <br /> — P•oenses.or causes of action that may arise becaup of installation <br /> T maintenance of the Improvement or other right-al-Way use <br /> he,eto applied for and further agrees to remove same upon notice <br /> Iron, the City and to replace public property damaged thereby. <br /> DEPARTMENT APPROVALS <br /> SEWED <br /> DRAIN/.GE <br /> NATER ri opgn,,; S�IONATLIRE OF APPLIUNT ,y <br /> STREET ADDRESS - <br /> i <br /> 3 <br /> c^/ �� y <br /> y �� _ �� DITr _� ZIP <br /> v€6To c T U TION ~` ((( DATt ��53 _ 57,, r- e <br /> TELEPHONE NUMBER ALTERNATE <br /> q– P�PSVED AS CONSTRUCTED DATE DATE <br /> I REFERENCECOPY FEE high <br />