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everen APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly witn Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS Q'1 <br />EVERETT. WASHINGTON wy LO4)bCT - PERMIT NO. —_-- <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: 7I� T C-- <br />HEREBY APPLIES FOR PERMISSION TO C1I a rnSS Ca S I r" en ✓���� P r <br />ij QJ <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />(� t -�c k Ld I I 1 <br />l x Is+ i vac, 111� e <br />be �t1J CC-fo S <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />CcL51 r%0 KCIIA-q 0� <br />A C,-�C-k\ bcaS 1 ct <br />0-P Ca51 r.0 <br />DRIVEWAY SECTION <br />roc, <br />fcrorn <br />I'i LIP <br />L 30 -� • Ir—t <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims lot damages. costa. <br />B-Penses, or causes of action that may arise because of Installation <br />and maintenance of the Improvement or other rightOl-way use <br />hereto applied for and further agrees to remove same upon nonce <br />Irom the City and to replace public property damaged thereby <br />SEWER <br />COMMUNICATIONS <br />DRAINAGE <br />TRMTIC <br />J- <br />WATER <br />PLANNING <br />SIGNATURE Or ICANI <br />ADDRESS <br />STREET <br />A Pq F C NS UC110N DATE <br />APPR V O 5 CONSTRUCTED DATE <br />CUSTOMER <br />TEIE ONE NUMeER� <br />ALTERNATE <br />DATE <br />1978 <br />