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everen � i <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or prin� clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS — ' � <br />EVERETT, WASHINGTON PERMIT NO.�L� „ <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO— <br />i <br />� a <br />iAT THE FOLLOWING LOCATION � S� 1 (i � l/7 <br />I DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />fl <br />i <br />IJ C" <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 />pRA1NAGE <br />WATEIi <br />� � StiiEET <br />�I <br />i <br />II, <br />� <br />DEPARTMENT APPROVALS <br />C04ENNi(.Al10N5 <br />TRqFfIC <br />f'LANNING <br />DRIVEWAY SECTION <br />� � <br />r���� � I" LIP � <br />I 3ll" I � �30" <br />�� -`t' <br />T�e undersigned owncr t�creby aqrees to holtl nntl save hnrmless <br />Ine Cily ol Everelt irom Tny and 11I claims lor tlamages. costs. <br />c.pCn5e5. Or cdu5es 0� PCLon Ihat may anSC Decause ol ini1311dIi0n <br />una mmnlenn�r.e o� t�e improvemcnl or other n9M�ol-wny ese <br />nr e10 apV��� lor antl Iwlner agrees lo remove snme upon nobce <br />liun� Ine CeV anU to rePlace �uoi�c o�on��rv ��ma9e0 Viere�y <br />GUNS7HUCTiON/iiS F3UILi <br />� <br />.Ss � �� ooc� I <br />1ElEPMON[ NUMp[R FLiC�NALL i <br />_—_. _ � <br />� <br />