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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly with ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS <br /> EVERETT, WASHINGTON � y� gPERMIT NO. 7 y Z 4 J <br /> APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY-'- 1 / 6,� /K.�M'� <br /> HEREBY APPLIES FOR PERMISSION TO 4f+� E` —�l <br /> GO�Jt�T� Z 5 T-=T lar�P II-Mf--rl7,LA-) c+ <br /> AT THE FOLLOWING LOCATION__ .3 // SO . i> .7 INr <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> t� <br /> o V <br /> 0D <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOA 60 D Y 7 is -1 1 <br /> COPY OF THIS APPLICATI01 J TO Bf POSTED <br /> ON JOBSITE. <br /> CALL FOR INSPECTION 259-'881 1 T <br /> 24 HOURS BEFORE CONSTRUCTION <br /> The undersigned owner hereby agrees to hold and save homeless <br /> the City of Everett from any and an claims for damages. costs. <br /> expenses or causes of action that may arise because of Installation <br /> ` and maintenance of the improvement or other right-of-way use <br /> hereto applied lar and further agrees to remove tame upon ochre <br /> DEPARTMENT APPROVALS frontthe City and !o replace public property damaged thereby <br /> SEWER COMMUNICATIONS <br /> DRAMAOET TRAFFIC <br /> , -1, <br /> WATER PI ANNINO SIGNADNAI URE Or AnniICAN1 <br /> STREET ADDRESS <br /> —a 3 y EII. zIn <br /> 'PROVEDORC 1 — T <br /> DATE `� 5' 7 — .y r ,l <br /> J 1A Cl <br /> IEEEPNUNE NUNOEn AV EnNAtE <br /> APPROVED AS CONSTRUCTED DATE DATE <br /> CONSTRUCTION/AS BUILT fit 1978 <br />