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. everett <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with mk <br />��ESS HA�� - YOU ARE MAKING COPIES <br />auouc woRKs � PERMIT NO. Q�/z�6— <br />EVERETT, WASHINGTON ' % <br />i <br />-+; / -t<. ,�._n �� �� ".a '��` / <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, �F ANY: <br />i� � .: �r T\ _ , , ., �:�i /1 <br />HEREBY APPLIES FOR PERMISSION TO ����� <br />AT THE FOI.LOW'ING LOCATION _ <br />/ i ') !. : / ,�-i r� r <br />DRAWING (WORK TO HE DONE) OR THREE PLANS ATTACHED: <br />�--i- �iOrd- \on o� �+c �C��Ve wct ( n <br />v.. �� ... }� 20 �..� �-�.� 5T 6'�e. Pcw ��1 <br />c�.r.ve....a� � �owc � 2_� �or.�. <br />r�.bb�.- _�a�l��- �p,,�� ,���� ��l-J�. �Ss,�� <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR fNSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER <br />DPAINAGE <br />WATER — <br />STN''_ET <br />COMh1UNICAT10N5 <br />TRAFLIC <br />PLANNING <br />qPPROVED FOR CONSTRUCTION oAiE <br />qPPROVED AS CONSTRUCTED onTE <br />iP'il�l ",L I�,'61'i_t;l�li��l i1GQU�ST�n <br />✓� -� -�°��� <br />�� <br />ORIVEWAY SECTION <br />jl'� LIP <br />30" � �30„ <br />Tho u�tlersignetl owner herrhy agrees lo �oltl an0 seve harmless <br />Ihe Cily ol Everett Irom any antl nll claims lor damages, costs. <br />eepenses, or ceuse5 0l aclion Ihai ��ny ause because ol installation <br />and mamtenanw ol Ihc improvement o� olher ng'i; ol-way use <br />hereto appbeJ �oi and lurther agrees to remove same upon notme <br />Irom Ihe City antl to rep�ace publ¢ property Oamn9etl increby. <br />r.�;, %%�C.)!,,j — <br />iELEPNJ NUMdER AttERNATE <br />� �I— ��=�J <br />on*e <br />