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everetl <br />� APPLICATION FOR RIGI-iT-OF-WAY <br />Type m print clearly wi�h ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBIIC WORKS <br />EVERETT, WASHINGTON <br />USE PERMIT <br />PERMIT NO. • � � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />DR.^.u'ING (WDP.n TO BE DONE) OR THREE PLANS ATTACHED: <br />���-P� ��P� S <br />� �-pP <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPEC"aN 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DRFINAGE <br />N'..'Ld <br />DEPARTMENT APPROVALS <br />COMMUNiCAiiONS <br />TR�FFlL <br />( �� /--�- / �/%� � Ci _ <br />APP P f CaN�9 UC ION � DATE <br />APPROVEDASCONSTRUCTEO oATE <br />!�:I ? I;�L Ii�IcPGGTION G' t,�Ui-:��i ; � � <br />DRt�'EWAV SECTION <br />+I'� LIP —�1 <br />�30" � _ 3���_� <br />Tha untlersigned owner here0y agrees to noltl and save harmless <br />Ihe Cily ol Everetl Irom any antl nll cleims lor tlamages, cosis. <br />expenses. or tauses ol action Ual may anse because ol installabo� <br />anA maimenance ol the �mprovemen� or other nghl�oLway use <br />n��c�o ai,n���a io� antl lur�he� agrees to remove Same uOUn no��ce <br />i�om Ihc C�ty dntl to ecplaGe pubLe proprrly Qaniagr� IM1ereby. <br />�"� `; - � 3b`i <br />IELEPl�ONE NUMtlER f LiEANPIE <br />CI RI I � _ __ <br />OATE <br />