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� veretl I <br />� �4PPLICATIOM FOR RIGHT-OF-WAY USE PERMIT <br />Type or prmt clearly wrth mk <br />PRESS HARD - YOU ARE MAKING COPIES � <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERMIT NO. �� � �, <br />APPLICANT (UNDERSIGNED) AND PIRM REPRESENTED. IF ANV: �� <br />HEREBY APPLIES FOR PERMISSION TO <br />i?cp A �• � �,.z �- c/.r „-, � y F—�.��-z _ <br />AT THE FOLLOWIhG LOCATION �U�O l <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />6 <br />• �LC.j�ICCL_L ��i /i'. L ) S_ /C<L�./ CCL L�iI '�� �L� �r_.c � <br />/ U � C <br />� �, � , r-.�,, �%��s—�. �D�,,,, _ <br />��;Jf✓� /%�,J�C /�./!G.- :.! � <br />/ <br />�; �� .� � �� �� � � �� <br />� � s� w . �- f '� �,,�„�.�.,;,. `��. <br />� � � <br />��,,,��. �e� ���`-�^� <br />� <br />, <br />pr���,,,,,, , .��. -��_ � <br />�_ <br />PERMIi IS VA'r.lA FOR 60 DAYS <br />COPY OF THIS APPLiCATI�JN TO BE POF.TED <br />ON JOBSITE. <br />CALL FOR INSPECTION 269-881 7 <br />24 H�URS BEFQRE CONSTRUCTION <br />SEWER <br />UF/.INnGE <br />STREET <br />DEPARTtJENT APPROVALS <br />COMMUNiC�TIONS <br />TRPiFlC <br />PLANNING <br />f /! , � <br />�` -:I T- �/ <br />! i ��n , r, <br />'� qppqOVED OR CONSTPUCTION DA�E / <br />1 � A <br />, � � a� <br />APPR VED AS CONSTRUCTE OnTE <br />I CONSTRUC?ION/�S GUILT <br />.��..��-�-e <br />DRIVEWAY SECTION <br />I'� LIP <br />�30� T T 30 � <br />The under5igne0 owner hereby agrees lo �old antl seve �armless <br />�he City of Everetl 'mm eny and all claims tor demages, costs. <br />expenses. or causes o� aclion thal mey anse oecause ol mslallahon <br />in0 maintenance ol Ihe improvemenl o� other ngnl-obway use <br />hcreto apphetl �or and IutlOer agrees lo �emove same upon notice <br />Irom I�e City antl lo replace pubhc p�operly O.magetl Ibereby. <br />' � ��� <br />SiGNATUR[ Of ACPL�C�1N1 / <br />3 22 Z 2. �R/JaG �(/�'. <br />ROsO�HE55�/ �.J <br />C l� l�'�� � . / � zu � <br />��,. z�,� <br />as5_zcsi asy-zs�3 <br />*EIEVHONE NUMDER — r. A«�A�A�E <br />j 3J � � - <br />1G78 <br />