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everetl <br />� APPLICATIQN FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT,WASHINGTON <br />I� APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: <br />HEREBV APPLIES FOR PERMISSION TO� � S� <br />�� �r ,�JE= <br />IAT THE FOLLOWING LOCATION IVtW IpK�. <br />i DRAWING (W09RK TO BE DONE) OR THREE PLANS ATTAGHED: <br />,l �LE <br />N G 4� -1 � _- <br />[� <br />F'ERMIT NO. �/��� <br />�9� O o�' � 5 � Pi C CC/j a.0 C' j�rJl�L /� /j <br />i R�I j, ��,c. „� �-.�'�se ,�G2c �v«dT l.5/� cL��� <br />�v �] <br />� <br />n <br />%i /C' E X � T To � �� <br />HC•uiiTT /J/iE , SN/aLL 8C 5/<AJCp � EX/T <br />,8c� T/�� �s / OE.S G F �!7 FZ 1 � C W ���� � i�C.l 1: �� I- t[ U.� t I l, . <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 />% <br />' j DEPARTMENT APPROVALS <br />ISEWER COMMUNIUTION$ <br />I <br />DBPIN/GE TR>filC ' <br />1'..�IEH PUNNING <br />STREEi <br />AS BUILI' <br />DRIVEwAY SECT'ION <br />I � <br />I" LIP � <br />L30" _ __�30" <br />i- <br />T�c undersignea owner hereby agrees lo had ana s9vc harml?gs <br />Ihe Cily ot Everetl Imm nny and all Unims lor OAmeges. costs. <br />e.pe�ses. or Cau5e5 0l acii0n Ihat may an�e beCause o� ��slallehon <br />antl mantewn<e ol IhC �m0�ovemCni or oihei ngM1l�Ol�way use <br />hereio appi�cC lor a�d lunne� agrces to remove same upo� nOtiCB <br />��om ihe Cily antl Io reV�ace pWl¢ pioperiy cfamage� I�ereby <br />� YC 25,� � C�+ � <br />CiTV $iP <br />2s9 - 4db� a�-8 - a.� � � <br />iELEPHONE NUMBEA ALiE�NATE <br />o..E/7_19 � <br />- �, <br />