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everen <br />� �PPLICATION FOR RIGHT-OF-WAY USE PEFiMIT <br />TyDe or priM Uearly wnh �nk <br />-• PRESS HARD - YOU ARE MAKING COPIES <br />PU31 I�; NORKS ppp��,��/ � <br />[dERETT. WASHINGTON J` M PERMIT NO.�L[ <br />�. _ _ E�9� A G �[Lia.. _ _ .. / <br />APPLICANT (UNDERSIGNED) ANO FIRM REPRESENTED, IF ANY: <br />HEREBV APPIIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION �S-3�L I•o=d W��� E�'.�°�t� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />�e-r �/ <br />,� �t� <br />c���C C��r' l0 � <br />--., <br />• �� Sy ��2 <br />���1«. � � <br />� ,� <br />� �� � <br />e' u�r� � <br />�K � �/r.a�H p� e <br />yPJ��� �S�,K� <br />!?P � e�__ <br />��� � : <br />PERMIT IS VALID FOR 60 DAY� <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE COPJSTRUCTIOP! <br />ORRINAOE <br />WNTER <br />SiREET <br />DEPARTMENT APPROVALS <br />COMMUN�C/ T IONS <br />TRqifIC <br />PIANNMG <br />APPROVE FOR CONSiNUGTION onrE <br />APPROVED AS CONSTPULIED OATE <br />INITIAL INSPEGTION REQUESTED <br />� <br />DRIVEWAY SECTION <br />tl„ LIP <br />� <br />�30�� I _f_30�� <br />The undersigne0 owner hereby egrees to ho10 enA sBve hermlees <br />Ihe Cdy ol Everetl Irom nny end ell tlaims lor Oemeges, coels. <br />ezpen5e5. Or C8u5C5 O� Bc�iOn ihBi m8y All9e �ecfiuSC OI in5ta118�i0n <br />dM memlPnanw of I�e improveme�t or olher nghPol�way use <br />nrre�o a00hed lor enC lurther agrees lo reinove same upo� �obce <br />�rom Ihe City antl to repia�e pubnc pioperry Axmeqed inereby. <br />�' ' ` � ��" ..l � /�r <br />SIGNAiURE O� �P� Nei <br />�s�_L__��� <br />i;l <br />�_�t %a- ��'� � <br />TELEVnONE N�E��� � p�IENrvA� � <br />3 - 2�- gr - <br />D/�E <br />