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APPLICATION FOR RIGHT-OF-WAY <br />U � Type or print clearly with mk <br />PRESS HARD -�YOU ARE MAKING CUPIES <br />, • ` <br />PUBLIC WORKS ' <br />EVERETT, WASHINGTON <br />� � ..�..,_._ <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANYI �'� <br />HEREBY APPLIES FOR PERMISSION <br />J ZO 3a /�i.�✓� s"_'. <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />ON JOBSITE. <br />INSPECTION <br />DEPARTMENT <br />SEWF.R <br />CONSTRUCTION <br />� LANI1�NG <br />1VATER ^ . �l <br />� . � �/\ ���, ♦ <br />STFEEt - � �=�� <br />:.�?_" <br />/ ` � <br />` ' S 20�P/ <br />qpPROVE FO CONST UCT`ION� "' ;� o rE ' <br />� ^ <br />1 <br />. j" ,. . • _.: ,i-��, i6 �v�Y � ( <br />a� �:; oATE , <br />�pp AS CO TPUC7, . � r <br />r..�.,�� j,1 7,r � <br />�,(%' CONSTitUCTIOIJ/AS 6UILT <br />PERMIT NO. � <br />I" LIP <br />rgp� �— �_30 J <br />The untlersigneC owner hemby a8��s 10 hold and seve �ermless <br />ihe Ci�y ol Evereil Imm any end all claims lor Oameges. cosis. <br />expenses. o� tauses o� aCiion that may Anse betaUSe ol in5Ia118Iion <br />antl mmnlenan[e ol the impravement or olher nghFo4wey use <br />hereto app�ied lor and luriher agrees to remove same upun nohce <br />Irom ihe Crty antl lo ecp�ncc publ¢ properly Oamagea Ihe�eby. <br />� [��✓ � / ��� <br />StGN�TUAE O� APP�IGANi <br />�,� �a ���,�.-ST — <br />AODRESS <br />�t'vs T j��' 'J <br />❑TY z�P <br />3ss' 3�G a _ <br />TELEPHON[ NU���ER �\LfEAN/iC <br />�T�y �'/ <br />DN E <br />