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#��isy <br />everen <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />♦' Type or print clearly wllh ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASH�NGTON PERMIT NO. � � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO�_�6yL,.� ��U f����L>� ,2/�Hl aF Gt/f�i <br />ATTHEFOLLOWINGLOCATION ���%— <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />� or,� P�,vs.gs��,edr.� �� b��--�b y-.� � � <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION 7d BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTIOM 25J-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEFARTMENT APf"""" " <br />DRIVEWAY SECTION <br />� � <br />; i" ur� <br />�f_3� T I 30„ <br />►}. <br />The untlersignetl owner hereby egrees lo �old end save �aimless <br />Ihe Cily ol Everoll Irom any nnd all claims lor Aemages, cosls. <br />expenses, or causes ol ection Ih�i may arise because ol in5iallation <br />antl maintenflnce ol Ihe Improvement or olher nghLol-way use <br />hereto ap0��c0 lor and lunher agrces �o remove same upon notwe <br />Irom the Cny an0 Io replate puElic property tlamagetl �nereby. <br />(aao) 771- �3�� --�- <br />TELEPHONE UM�Eq q�iENNAtE <br />�'rla�,r�- lo, �9B/ <br />DATE <br />