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everen <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS L <br />EVERETT. WASHINGTON `J PERMIT NO. J <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTEfn, IF ANY. �/�.��—�%�� VC LtJ 1«1A.Y.S 14z/i <br />HEREBY APPLIES FOR PERMISSION TO t041S7- ? UG7 <br />3/7 <br />AT THE FOLLONING LOCATION L� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-861 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />wATEn <br />DEPARTMENT APPROVALS <br />COMMIIW CAIIUNS <br />1n`AV' W -- -- <br />iNG <br />PLANN---,, <br />STREET/ <br />Zz <br />APPROVED FOR CO RU 10 DAiE <br />I' z <br />A R ED AS CONSTRU iE0 DATE <br />DRIVEWAY SECTION <br />I�I j I" LIP <br />The undersigned owner hereby agrees to hold and lave harmless <br />the City of Everett from any and all claims for damages, costs <br />e-pensesor causes of action that may arise because of installation <br />and mamlenAhce OI the Improvement Or Other rlgfll-of Way Use <br />hereto appliee for and further agrees to remove same upon notice <br />ham the City and to replace public property damagrM theieby. <br />oleeof Or APPI n_nN� V <br />�D <br />flbnf Sti <br />CITY bP <br />TELEPHO E NUMBER ALTERNATE <br />%/ 7/70 <br />DATE <br />CONSTHUCTION/AS QUILT <br />FEE 1978 <br />