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�� . .,i <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT ,, ' <br />Type or print clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />Pueuc woaKs �D� C� C� <br />EVERETT, WASHINGTON PERMIT NO. <br />` /�iJ <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: `ry/ � Nr ��r �/\ <br />HEREBY APPLIES FOR PERMISSION TO USr /i� �f�l S%/NC D�./ � V h�� K! 4V G f%Q/�j� —�,LC/j <br />—�•-- <br />ial�l�//✓C- f) </?i��/ri L /�/.�Rt� /N C- AR�iA <br />AT THE FOLLOWING �OCATION �� 7 S� �r S v�/ �/i�✓� C�%ST �N �_ <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 D�AYS <br />COPY OF THIS APPLICATlON TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-887 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER <br />DRAINAGE <br />WATER <br />GOMMUNILATIONS <br />TRAFFIC <br />P�ANNING <br />� /_/�-� <br />; DATE <br />� 7 _ j� U � <br />DATE <br />CONSTRUCTION/AS BUILT <br />• 'a <br />. � <br />� <br />DRIVEWAY SECTION <br />1'� LIP <br />I'3� T I 3� <br />The undersigneA owner horeby ugrees to hold entl seve harmless <br />Ine City ol EvereU Irom any an0 ell claims for tlomages. costs, <br />expenses. or eau5es ol ettion ihat may arree because ol m5lallali0n <br />nntl mamlenance ol Ihe improvement or othar rigM�ol�wny use <br />�erelo aDPhed lor untl lurlhcr Bgrecs to remove snme upon nouce <br />Irom Ine Cily an0 to replace Ou01¢ p�operty damageA Ihcreby. <br />//✓ %'w V�/�� <br />�S GNAiUAE F PPPLICFNi <br />,G/7 5/ 5� 5 k) _ <br />n oaes: <br />��erPj� J,f�o3 <br />GiTV Z�P <br />�S� 9� 7 � <br />TELEPHONE N�AIBE� �- ALLCtiNAiE <br />Q-,l�-�-Q / /9F10 <br />OATE <br />fEE � 9�8 <br />