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. i <br /> everen <br /> � APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> Type or print clearly with ink <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WORKS JT� <br /> EVERETT,WASHINGTON PERMIT NO. <br /> , <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED, IF ANY: V/�CG/N!A FOn'C,v]U <br /> HEREBY APPLIES FOR PERMISSION TO T/� ON %J Tf/c G/T/ES EX�5 TiNG / Z H DiC�i N � /�VY <br /> � / /�... F'" <br /> . . . � � Tr� c v—� — <br /> ' � - ' i. _ : .° �1 'M E�S o r! ,� c: � <br /> ATTHE�FOLLOWING�LQ O <br /> _� �,. , . �� �� . � <br /> DRAWING (ORK TO BE DQNE) OR THREE PLANS ATTACHED: <br /> MRKc Co�t1�t1FCT/d rtJ TO CR Z'G N �AS/� w�Ze`f Ca I(1�°/���� <br /> PI P�=. <br /> , <br /> 14EMd���'/Q��•�i9c� 7'/1/ITR�ET/d.t1 oF rH�'S�bEGr�/?�,,�� <br /> e u�B f�u'77�E.� N�eEss�9�Y Td/►�1��G�ar�J�Tidel� <br /> I <br /> � <br /> I <br /> ' /�/�f�• r veS t. <br /> !'js �'�s C'oc.l [3i�ssarJ � '� <br /> DRIVEWAY SECTION <br /> PERMIT IS VALID POR 60 DAYS l� --� I <br /> I <br /> COPY OF THIS APPLICATION TO BE POSTED i" LIP � <br /> ON JOBSIi'E. I 30" I L3o"J � <br /> CALL �QR INSPECTION 2a9-8a1 1 I' �'�`—'� I <br /> 24 HOURS BEFORE CONSTRUCTION The un0ersigned owner hereby agrees to hol0 antl save harmless I <br /> the Cily ol Everetl Irom any nnd 011 claims lor demeges, cost5. <br /> expense,,or causes ol aclion t�at may arise 6ewuse ol installation i <br /> an� mamlenante ol I�e improvemen; or other ngh4ol-way use I <br /> hereio dpphetl for antl Wriher agree5 Io remove Same upon nolice i <br /> Irom Ine Crty an� to replace pub�ic properly tlamagetl Ihereby. <br /> DEPARTMENT APPROVALS . � <br /> SEWER COMMUNICAti0N5 q� <br /> OR�INAGE TNAFFIC / �� <br /> C(/ <br /> WATEfl PLANNING SIGNRTUR f APPLiGANT � . .. �/�� I <br /> /73o O /3.� 7�f� <br /> A�� DRE55 D• / �/Q/�P� >� ! <br /> STPEET �„��� <br /> pp �^�'/Cp/(y I <br /> . CIT��J'7�0 O ZiP <br /> APPROVEO FOR CONSTAUCTION DniE . I <br /> TELEPnONE NUMO_�� E�— �Al1ERNAiE <br /> I��f �`—.._----- �i- G - 7 �'` � <br /> DATE � OATE I <br /> Gb'y✓.,�� No rf,. � <br /> CONSTRUCTION/AS BUILT FEE �g78 <br />