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everetl <br />� APPLICATION FOR RIGHT-OF-WAl' USE PERMIT <br />Type or print clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS �. <br />EVERETT, WASHINGTON P�RMIT NO. �a� 1-?? 1 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF AN'f: <br />HEREBYAPPLESFORPERMISSIONTO =x'"-�.�.1 0�2�).'�W��� i— 3��iL�9 ��:.�'vC' <br />AT THE FOLLOWING LOCATION_�.��_� C�Ci H\+nm'I- /-` V� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />�f,,)F���. IJ� % �I�iLi�-f� / t�)"L /NS�L7" ir�.n� <br />01-� � {' � � � . <br />PERMIT IS VALID POR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTIOPI 259-881 1 <br />24 HOURS BErORE CONSTRUCTION <br />SEWER <br />pRAINAGE <br />SIREET <br />'DEPARTMENT APPROVALS <br />COMMUN� tAL�ONS <br />PIRNNING <br />I.f;T� �,. ,.; 3/S�c�/ <br />APPROVED FOg WNSTRUGTION � y y OaTE <br />X <br />13' <br />�-�� z.� C� /.� 6( <br />APPFOVt AS CONSTRUC� E .. nniE <br />DRIVEWAY SECTION <br />I" LIP <br />�30" _ �30" <br />The undersigned owner h^reby agrees to hot� and save harmless <br />ihe Ciry of Evere�t Irom any and all claims lor aamages. cosls. <br />e•penses. or causes of action Ihal may ans � because ol msla�latio� <br />2nd mamtenBnte O� �M1e �mprroc�neni or Olher nph4ol-way u5e <br />�erelo apP��ed lor Bntl �urtlior agrees to removc same �:^on nobce <br />Irom Ihe City and lo repiace pubhc property tlamagetl Nereby. <br />/ ! � � . i/� � <br />.7 _ _ <br />Si6N UIiE O� API'L�C/.Nl <br />, y, l �!)� / //_� '2Li� <br />0o ts <br />� _ � ' � ���a / <br />�,,. � Z�� <br />TEIEVN E YUM E�' ��� nU[PNniE <br />-�� � � - ---- <br />�,ntt <br />