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I <br />r� <br />0 <br />everetl <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />� Type or prinl clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS / � <br />EVERETT, WASHINGTON PERMIT NO. �� <br />APPLICANT (UNDERSIGNED) AND FIRIv1 REPRESENTED. IF ANY:_ <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION �'S /� l��` �/' / r� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO SE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DAAINAGE <br />1VATEP <br />SiREEi <br />DEPARTMENT APPHOVALS <br />�OIAMUN�C4110Nti <br />TRAFiIC <br />Pl/ NN�NG <br />C��� .�-1 � ��� 3/ So <br />, <br />APPROVED OR CONSTRUC7�ON �'�<<� <br />�_ f �,� �.?��L— <br />y pqtC <br />!✓�.�/� /N �C7� <br />C�.��� .' =`�i RUCTI^iJ//1S t�UIL�; <br />�i P <br />DRIVEWAY SECTION <br />� — ---� <br />�- j I,� LIP <br />�30��� —� .I_30" I <br />i- <br />� <br />The undersigned owncr OereOy agrees to �old and save hnrmless <br />Ihe C�ty ol Everett Imm any and nll clmms lor Gameges. cosis. <br />eAp�nses, oi c2use5 0� ����on 1hd1 ni0y anse �ecause ol installabon <br />intl mamtenOnce ot ihe imn�ovemCnt or oihei ngn4o4way use <br />he�c�o xpVlice lor an� Wrlhe� agrees �o remove Same upon nOlme <br />bom Iho City and Io �epldte puUiir D'ope��Y 4�^�a9etl �heicby. <br />p <br />li <br />�/����"�� �/��Gr�/ i <br />SiGNP`TU'�E Of <PPI/IC�A�Nij/// "�/�i" ��� •, <br />4! 0//V/./V ��jc ' II <br />/ /�� ' /�f //-� I <br />allDaES�/L�`-�/.�..r ��✓/ ` . /!J �� I <br />/L � <br />CITV Z�P i <br />Z� � -�C� i <br />iELEPrtONENUMBCf� al�!'��NniE � <br />/(/,�c;�� /7�.`�� - ' <br />f)PTC <br /><<� <br />1978 <br />