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. i . < < <br />♦,vereM <br />"� APPLIC�AT60N FOR RIGI.OT-OF-IMA1P J&E PERIInIT <br />Type or Drint clearly with ink <br />PRESS HaRD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. �� �.— <br />EVERETT, WASHINGTON • <br />„ ,�cJ��E7T ,Cfc Q�Q, /.cJc . _ <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF� AN.: — — <br />HEREBY APPLIES FOR PERMISSIi-i� TO <br />(,! SE �a�iST /aJG ,r���/� c�fF•/ o�F c�� <br />/¢�L E✓ — <br />AT THE FOII.UWING LOCATION <br />�sai ��,o�-,�o -- ,��E�,� T� — <br />DRAWING (WORK TO BE �ONE) OR THREE PLANS A.TTACHED: <br />�� <br />� ►"� „ ��--�-1,,� � �/ �� 0��1/ <br />/w <br />PERIWIT 1� VALID FOR 60 DAVS <br />COPY OF THIS E.?PLICATION TO BE POSTFU <br />ON JOBSITE. <br />CALL FOR IWSPECTION 25J-�81 9 <br />24 HOURS BEFORE COfVSTRUCT'IUN <br />LAAINAGE <br />WATER <br />DEPARTMENT APPROVALS <br />COMMUNiCnii0Y.5 <br />TRAFFlG <br />VLANNING <br />STREET <br />r � -��,-��U <br />�OVED FOR NS PUCTION OnIE <br />� r _��� V � <br />qpp AS CONSTRUC D ontE <br />,�,����;7i���.,r�o���;� �.� �;u!�r <br />r <br />��� � G��� <br />�! . <br />�� <br />DRIVEWAY SECTIOPI <br />i aa� I - -4 —�!..30`'J <br />r--�r---- v <br />The undersigned owner hereby agrees to hola ana save harmies> <br />ihe Ci�y o� Evere�l Imn any and all claim> �or aamages, cosis. <br />enpenses. or causes ol action ihpl may arise because ol installabon <br />antl maiNen:�ncr o� �hr improvemrm or other nght-oi-way use <br />hereto apPLetl �o� an] �urther ag�ces to rBmove same upon nobce <br />irom Ihe City and �o �epiace G��bi�c p�operly d�mogetl Ineeeby. <br />��� / _— _—_ <br />t,c. � ( 2i c: s✓ <br />9GNMU��E O� APVLIGHNi <br />.� �U�o �tJf[�lc�EfN u//�'l� --- <br />FDO�E55 <br />t�UE��T'r %�Z o 3 <br />CRv ZIP <br />���� �/� / <br />TFLEFNONC NUMoBER � ALTCNNAfE <br />nF.E �—J _�V —_ <br />