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everen - <br />� APPLICATION FOR RIGHT-UF-�fR"AY USE PERMIT <br />Type or print cleerly with ink <br />PRESS HARD - YOU ARE MAKWG COPIES <br />PUBLIC WORKS � <br />EVERETT, WASH�NGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM FEPHESENTED, IF <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION �-; 3 13 r�PJ''O � �✓�' — <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />l <br />i <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POS7ED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DFAINr1GE <br />' WATEP <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLPNNING <br />STPEET <br />A P VE� S UCTION � o� � <br />APPFOVED AS CONS7RUCTED DR�E <br />CUSTOMER <br />`� <br />DRIVEWAY SECTION <br />� � <br />I'� LIP <br />1�30 � 'I'T�� <br />The untlersignetl owner �ereby egrees ta noitl anC seve hermless <br />ine City cl Everetl Iwm any enC all cleims for Oamages, costs, <br />expen:as, or causes ol ection �ha� may arise becausa ol inslellation <br />antl mainlenance of Ihe improvement or other righl-ol-way use <br />hereto .+pplied lor antl lurt�er agree5 io remove same upon nutice <br />Irom Ine Qly an0 to replace pubbc propeny tlema9etl ihereby <br />� ���� <br />IGNNTURE JF PPtICRNT - <br /></Js 2 L FUGI/�-Fip <br />nouaess <br />CvT !,�/.o�lJ 4�2C2� <br />LIT` S� SC / / LIP <br />TELEPrONE NUMBER ALLEFNFiE <br />