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!Y!f!n <br />e <br />APPLIC.�►TION FOR RIGHT-OF-WAY I�SE PERMIT <br />Type or print cl^ady with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO.�-�- <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANV: <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION / A 7 'S � rD0°' W 2 4 _ <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 />6N JOBSITE. <br />CALL FOR II�SPECTION 259-881 il <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />ORRINAGE <br />14ATEfl <br />DEPARTMENT APPROVALS <br />COMMUNICPTIONS <br />TRAFFlC <br />P�ANNING <br />� <br />CONSTRUC�ION/AS 6UILT <br />DRIVEWAY SECTION <br />I'� L!P <br />30" ' � "; �� <br />The undersigned owner hereby ogrees to hold and seve harmless <br />Ihe City ul EverMt Irom any antl all daims lor tlflmages. rosls. <br />expenses. or causes of aciion Iha� may anse because ol msl�llabon <br />an0 mmnlenance of t�e impmvemenl or olher nghbol-way use <br />herelo apphoa lor and lurlher agrees lo remove same upon noI¢c <br />imm Ihe Ci�y antl lo replace publ¢ pwperly damagetl ihereby, <br />N {AA, eo .I� c. �t', S • <br />� ����%�i' / <br />SIGNAIURE OF APPLICANi <br />���� � . - <br />P ORESS � /, <br />�-�A�� � laJfCS��, % /� / _ <br />CITY Z�P <br />�av�� �8z �7'f- I <br />TELE�MONE NUMBER ALiERNALE <br />OATE <br />