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t - - - - - -- - . <br />_. _�.. . .. .:__ � <br />` ' � � � �� � g7o� <br />� <br />�� <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />� Type or print clearly with �nk <br />`� PRESS HARD - YOU ARE MAKING COPIES <br />� PUBIIC WORKS <br />EVERETT, WASHINGTON PERMIT NO. O/4y $ <br />APPLICANT (UNDERSIGNED�� AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION <br />� <br />AT THE FOLLOWING LOCATION <br />l� <br />cIRAWING (WORK TO BE DONE) OR THRrE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWEH <br />DNAiNAGE <br />WAIER <br />SiREET <br />DEPARTMENT APPROVAI_S <br />COMnWN�cAiioNs <br />iRAFfIL <br />� <br />T— � i h p <br />AP R O 'F�LTIOr��� f �* 'D�— <br />L�% _ '. �S s��7 � � <br />APP D AS CO .�TRUtTED OnTE <br />CONSTRUCTION/AS BUILT <br />DRIVEWAY SECTION <br />� � <br />��� +I" LIP <br />r3p'�I T ��30" f <br />� <br />The un0ersignetl owner hereby agrees to �oIC antl save hermless <br />ine City ol Everett Irom any enC aIl cleims for Aamegea, cosls. <br />eapenses. or cnuses ol ar.tion I�et nay arise because ol instellalion <br />.�nd mxintenxnce ol ihe impmvement or olher nghbol-way use <br />herclo appliea lor and lurther ag�cea lo remove snme ��Oon nobre <br />Irom Ihe Qry antl to replTCe pubLt properly aamegetl Iner=by. <br />'�_� � . LGfGt_ . � <br />SIGN4t E O� APVLICANi �I <br />� O' ✓ L'� /�c�. <br />'b � L��� � <br />�nooncss �r �,'�' <br />iiGn—�(i( � �'/t/ • /CJ�U � <br />Cliv Z�P wpRK • <br />✓�5-�-�� / n���C� <br />TELEPHONE NUMOEP ALIEANATE <br />�z -i�- �'� - <br />OFiE <br />�iZ:7 <br />