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everen <br />� APPLICATION FOR RI(�HT-OF-WAY USE PERIIAIT <br />Type or print cleaAy witn mk <br />PRESS HARD - YUU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. �� '� - <br />EVERETT.V/ASHINGTON <br />APPLICANT (UNDERS.GNED) AND FIRM REPRESENTED, IF ANY:_ — ' ' <br />- 1 `�.. �,�: � ..r •'� <br />HEREBY APPLIES FOR PERMISSION TO �� � ��. �. <br />_ �! l�' X i i i i� d/� �� �1 F <br />AT THE FOLLOWIN3 LOCATIOD <br />�RAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />— G�r�ss ".8'' �5�1��9� T u�� rf�i.r� ��i���� ,P��Nr_oF-u.�i9/- <br />-" D,EI dG /�[/N % A T P.YD�r �'Tf� �/�L1G T4 �3� f? % - � %a F�iPDiK <br />L'� itl ;�� � ir�k= �l � Yh'> iG� Uf �,�'/itJG � c�/ J9Ur �.. <br />_�,s�c� .-.-,, <br />.� �.__. <br />pERMIT IS> VALID FOR 60 DAYS <br />COPY OF TIiIS APPLICATION TU BE POSTED <br />ON JOBSITE. <br />CALL �OFi IWS�EC�10N �59-881 1 <br />24 HOURS BEFORE CONSTRUCTlQN <br />APPROVALS <br />STREET <br />___s����— �— — <br />APPfiO E[1 FOR CONSTPUCT N Dntc <br />:. I � . . � . . . i _ . __ - _ .. , e t L __— <br />�-si /l i <br />eRivEwa•r sEcriorv <br />��-- � I" LIP � <br />3� — � 30" � <br />1 —� <br />The untlersigned owner hereby agrees �o holtl entl save harmless <br />ihe Cily of Lve�etl �mm a�y nnd all claims (or damages. cosls, <br />espense5. or causes ol .:Cbon �tiat may arise because o� inslallalion <br />unC mzmlenance ol the impiovemect or olner righbol-way use <br />herelo apphed �or nr.tl �utlher agrees lo remova same upo� nol¢e <br />ircm Ihe Cny ana lo replace public p�operlY �amageA t�ereby, <br />SIGNAiUR[ OF AFPLICANI <br />r, <br />iELEFNONE NUMNER �i��A�A�� <br />nif <br />