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everen <br />� <br />APPLICATION FOR RIGHT-OF-WAY USE PERMiT <br />� Type or print Clee•ly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO._��� <br />PUBLIC WORKS <br />EVERETT, WASFIINGTON <br />APPLICANT (UNDERSIGNED) AND FIf�M REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO ��Sf �`� r G'-3S, �SQ/i/D�L� �/lI% S <br />AT THE FOLLOWING LOCATION !7 D% E�%�' � 4 i�C �'�l �'ync/ — <br />J <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 INSPECTIOM �59-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />�flA1NAGE <br />WATER <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />PLFNN�NG <br />STREET <br />c� l�- - a 6 -7S <br />PPROVED FO CONSTRUCTION oArE <br />' I _ I L�i�,/ <br />DRIVEWAY SECTION <br />�� j I" LIP <br />f30 •i "T�3—�1 <br />The undersignetl owner hereby agrees to holtl an0 save harmless <br />the City ol Everelt Irom any ana all claims lor damages, costs. <br />expenses, or causes of action that may arise because ot inslallation <br />antl mamtenance ol the improvemenl or o�her right-ol-way use <br />hereio aOP��etl lor dntl further agrees lo remove saine upon nollce <br />Irom ihe C�ty antl lo replace pubhc pwperty Oamaged Ihereby, <br />l�v������'�/��- <br />— `7 <br />SIGN/TURE Uf APPLICFNT <br />7� y •- '�j O <br />FOOPE55 // <br />% �m��`,(Y G(/ai y�1�0�0 <br />�"Y 7 7�.1���J 776 656/ <br />TELEPNONENUMpEf� %� N� �� <br />/-�- — 3— 7�/ <br />