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•• �f / . <br />+ • <br />!V!f!„ <br />e <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or pnnt cleatly wlth mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO. G -3 � <br />PUBLIC WORKS <br />EVERETT.WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO—�Jy� �^�!/F� ���CSS �/��� <br />AT THE FOLLOWING LOCATION � / �`� � ����'�<<< � ^�� �'^� �� � / �" -- <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />�QJg fGY�. ��1? O.P4l�ib�d> — .ff1 DTH�� s��i'�L .�,c�l�/��M�•(►r� <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 />Df-PARTMENT APPROVALS <br />i � <br />AP O FOR CON H ON DnT <br />9 <br />` ��� � % /��,�/G <br />qp ' . NjTRUCTED � OATE <br />� �. � . �� I '�I�.,. ...'�''�I_�'� <br />DRIVEWAY SECTION <br />� - -� <br />+I" LIP <br />� <br />�3p�� �30,� <br />The unUersigned owner hereby egrees to holA antl save harmless <br />Ihe City of Everel� Irom any OnG nll claims lor aamages. costs. <br />exV�nses. or causes ol acimn Ihal mav arise bewuse ol mstaila�inn <br />an� mamlenance ol Ihr nnp�ovemrn� m olher ugM1�-ol-way ucr <br />h��ielo apPlied Im an� IwPmr ngrees lo iernovr s.�me uPon neb�r <br />horn V�r GdY �ind lo np�ao� pubhc P�'�C••�tl' �auiale�l Ilier.•b� <br />� <br />���.. ,S �� - -- — <br />SIGNALURE O� /•PPLICANi <br />-�•(�� i <br />.rL� ✓',_. � / <br />�:�U�E55 <br />���i�U �:,�,_., C/�-.u( - <br />G�TY ^ 21P <br />��a2�' � L�'` <br />� <br />"T�f�ONE NUMBER >LLERNAiC <br />� <br />19?A <br />