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everett <br />i, � AP�LICAT'ION FOR RIGIiT-OF-WAY US'c PERMIT I <br />i Tyne or print cleady with mk i <br />PRESS HARD - YOU ARE MAKING COPIES � <br />I PUBLIC WORKS g� A�3 �� <br />� EVERETT, WASHINGTON � PERMIT NO. I <br />� ���, c,� t�� S1_.. c. ., � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HERGav euai iFc cna aFRMISSION TO_ ��--"�`-`�� <br />I <br />i <br />i <br />I AT T <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />/� 5:.� U-�' �`-Z'��� V �\ U��.� <br />� rJor � a'= <br />�r'C�'Y1 C Vl C� �� � Vi'� D C] �� i E� �i <br />I�iP� �tD b�. iNs;t1�C.���J ?a,L � <br />1Pr�2oJ�.�J PL�1cJ, c`�c �:,�i Pi��c,�i�-�cvJ� <br />TD 3e INSTr)ltf£v7 170cJN. <br />�' <br />�. <br />. � <br />Y/� � <br />� 1� <br />,� �\: <br />, � , � � � <br />, /,' i 1 1 � / \J ( <br />, ,� _, <br />%i� <br />G�� �ii �=��r+ rlh�ZoPA� — <br />Na �,�A�E� a�� <br />i� r ��� <br />PERMIT !S VAL.1� FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOFi DNSPECTION, �5:9-1Bg 1 1 <br />24 H�JIlRS BEFORE CON:;TRUCTIO!'1 <br />SEWEH <br />Oli/INAGE <br />WATER <br />DEPAFTMENT APPROVALS <br />COMMUNICAtI�NS <br />TPPFfIC <br />PLANNING <br />I STREET <br />/ i7� L i /<J�'� //�S�iD <br />� APPWOVEDF[�FiGUNJIHUU���n / DATE <br />' � � r� � / � � /1 ' � �/ ` ' ( <br />�, qpp % V, AS CONSTRUCTED oATE <br />/ <br />CONSTRUCTION/AS BUILT <br />�0.yer <br />DRIVEWAY $ECTION <br />�� � <br />r` 11" LIP <br />30" �3���� <br />Thn undersiqneE owner hereby ngrees �o ho10 entl seve haimless <br />Ihe Cily ol E�ereC fmm any anA nll claims lor damages, rosis. <br />eapenses. or Causes of action �Imt may arise betause ol in=tallaiion <br />ana maintenance ol Ihe improvement or olher rignl-o��way use <br />�ereto apP�'�tl lor anE funher a_reas �o 'emove same upo� nobce <br />Iwm Ihe Cily and lo ieplace pvblic G�oP�riy tlamageC IM1e�eby. <br />-�co: � <br />L <br />,.,,Gu):.i�..1�A `. �. <br />�: � <br />ci� J J ``C?oY4 ��J�J� � <br />TELEPI��ryE�A�B� � AUERN <br />C \ 1 `1 � <br />OATE <br />� <br />� <br />i <br />