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everetl �u�°.�/�,yT� <br />APPLICATION FOR RIGH7-OF-WAY USE PERMIT <br />Type or prmt clearly wlth ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS �CJ�/7� <br />EVERETT, WASHINGTON PERMIT NO. � <br />t <br />APPLICANT (UNDEPSIGNED) AND FIRM REPRESENTED, IF ANY: � <br />HEREBY APPLIES FOR PERMISSION TO ��ST�L(C�7' ,EX T.PC1D�.l C�oNc�t Tr_ (�(J�_ <br />AT THE FOLLOWING LOCATION <br />DRA1rvWG (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />�De!'a����e� ��a �15 ca��idU�.���� 5�l7���3 <br />� <br />,• <br />F�ERMIT IS VAL.ID FOR��,.O �1d�YS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL F�kR INSPEG'TIOE�1 259—�8t1 1 <br />24 HOURS BtFORE CONSTRUCTION <br />DEPARTMENT APPRm AZS <br />� COMMVNiL�T10NS <br />S S Y'd�y�� � <br />PLANNING . <br />S /� <br />APPROVED AS CONSTRUCTED DnTE <br />1;EF'-HL=I��CGCOPY <br />,�'T_ =: <br />, _ <br />;�,�,,_ - <br />DRIVEWAY SECTION <br />(.'""'__ � <br />I <br />r� � I" LIP �� <br />�30,� �30�� <br />The undersigretl owner Imroby n�rees W �old antl save hormless <br />thn Cily.ol E�erett Imm any and all claims lor damages. co5�s. <br />eaoenses: or cnuses o� eE�ion ihal may ai,se becausc oi instailahon <br />und mainlennnce ol Ihe improvement ar othei nghbo4way use <br />herclo,dpDlictl lor ailtl lurllicr a9rees �o remwe same upon nobcc <br />Irom I�e Ctly-nntl lo replate publ¢ properlY dnnt�9Ctl Ineieby. <br />`/^�. . . _ . . <br />. � : �' ^�:�1 i <br />r � �"' ' �� ,-!-�— — <br />SIGNa1UAE 0� �PP�IC4NT, r <br />l� (.�� � '� �� � O <br />.,��„�L/r.• f% �%n�0� <br />�,.� Z�N <br />�s3-i,',3s� <br />�LIEVHONE NUMf1ER A�iERNFLE <br />�' �/- �� <br />DAiC � <br />bJ,r,.�.= <br />�F� - ,s�s <br />� <br />r� <br />