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M APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly with Ink <br /> PRESS HARD - YOU ARE MAKING COPIES p <br /> PUBLIC WORKS PERMIT NO. 7 3/.2 4 9 <br /> EVERETT,WASHINGTON 1 � <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED.IF ANY <br /> ni.. l <br /> HEREBY APPLIES FOR PERMISSION TO i <br /> GOhJ/�Te <br /> -2"i15 T-=T �6P F-fjAt.�_�IA <br /> AT THE FOLLOWING LOCATION 311 ✓O r �� S INT <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> IAI � <br /> -Litzt� <br /> U <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DJV <br /> COPY OF THIS APPLICATION TO BPOSTED I" LIP <br /> ON JOBSITE. �1 3011 y3o" <br /> CALL FOR INSPECTION 250-881 1 <br /> 24 HOURS BEFORE CONSTRUCT16N The undersigned owner hereby agrees to holm And save harmless <br /> the City of Everett from any and all claims tot damages. Costa, <br /> lKpanses.or causes of action the t may Grin oecavle of Installation <br /> end maintenance of the Improvement of other right-of-way use <br /> hereto applied for and further agrees to remove same upon nolic <br /> from the City and to replace public property damaged thereby <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICATIONS , <br /> DRAINAGE --_T �RArFIC ` <br /> WATER PLANNING <br /> SIGNATURE Or APPLICANT <br /> f <br /> ADDRESS ' <br /> STREET <br /> C,T` zlP <br /> APPROY DATE lJ S' 3 - A t f L) <br /> T9EEPnONE NUMBER ALIERNAIE <br /> APPROVED AS CONSTR�-- DALE DATE <br /> CONSTRUCTION/AS BUILT FEE 1978 <br />