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evered <br />� APPLICATIaN FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly wilh ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. 8� <br />EVERETT,WASHINGTON <br />pPPLICANT (UNDERSIGNED? AND FIRM REPRESENTED, IF <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION /� �� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />r; -�:i •�l�. G-1�"� <br />VV <br />d" _ 5.3o�ga <br />f'y.L .��-e- ��L�C-�i' � �^� ��� <br />/' � �j 0 � � i' �YC) <br />! '�rGL�/r <br />U <br />PERMIT 1£� VALID FOR 60 DAVS <br />COPY OF TFiIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WAtER <br />STP[Et <br />DEPARTMENT APPROVALS <br />COMMUNICRT�ONS <br />TR�FfIG <br />PLANNING <br />�� -s' 3�-�� <br />OAIE <br />� 3-i�' 8/ <br />ATE <br />CONSTRUCTION/AS RUILT <br />."����� ���� <br />DRIVEWAY SECTION <br />�� � I" LIP <br />30" _�_30 <br />The undersigned owner hereby agrces to holC on0 seve hermless <br />�he City oi E�ere�l Imm eny and all claims lor dameges, costs. <br />e�penses, or causes of oction Ihal may nrise because oi msinllelwn <br />and mmntenance o1 Ihe Improveme�l or olhee nghl-obwaY use <br />herelo apPhed lar antl Iurlher agrces lo remove same �ipon no�ice <br />Irom Ihe C�ty and to replacc pu�lic p�opmty Onmaged Ihereby. <br />��vG �+ /Z , �odd �.4SSa� <br />C.ri� �,'•'--fT �-/ '� '„s� � <br />SIGNFTURE OF APPLIGNT - <br />5Z0 Ce��i�/ 131o�q <br />�DDPE55 <br />s���P �v� y8'/SS <br />�,r. <br />62z-sz 3s- <br />tELEf'IiONE NUMOE� ALTERNPiE <br />3 fll�r� I l9 � - <br />OAT[ <br />