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eve.en <br />e <br />� <br />� P <br />APPLICATION FOR RlGHT- F-WAY USE PERMIT <br />Type or print clearly with mk <br />PRFSS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIFM REPRESENTED, IF ANV: <br />HEREBY APPLIES FOR PERMISSION TO <br />PERMIT NO.� <br />AT THE FOLLOWING LOCATION_ _ _/ �� �/ U� 1•✓ � <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />� �� � i �-�- ��� �-�S �c <br />� c,.�- r���-� � -f< <br />�� ��ss�e� � � wa� �rod� <br />� / ` �'' � l �^�cn' ° I7� /cj�iJOJ( S cT��. <br />�1� <br />-�,�4- � � I� C C..�-° . <br />COPY OF <br />ON JOBSI' <br />CALL 1� <br />24 1� <br />IS VALID FOR 60 DA <br />� <br />p� Pv ✓ � uc..-_...,� � <br />, t '�-� ��,-�� <br />+ 12I2�1'.Ul IM. � ����-+��U <br />-� �-�,�� � <br />� � �, <br />I� ; v�� ,, f � <br />� �j,'';��;,, �.� <br />I� � <br />;� <br />IS APPLICATION TO BE PO�TED <br />R INSPECTION 259-881 1 <br />1RS BEFORE CONSTRUCTION <br />D,EPARTMENT APPROVA�S <br />COf!STRUCIIOi�!�i1S [�UII_T <br />ORIVEWAY SECTION <br />� � � ,.;. � <br />_ '- <br />r� � I" LIP � <br />4..30�� —_ 30,� <br />The unCersigned owner hereby agrees lo hole and save �armless <br />Ihe C�ty ol EverMl imm any an0 all claim5 lor damages. Costs. <br />e.penses, or causes ol action ihat may anse because ol mstallation <br />and maintenance ol ihe improvemenl or ot�ei nghpol�waq use <br />hwelo apphed loi anA furlhe� agrces io remove same upon nohce <br />bom Ihe Ci�y nnd lo ia.pld[e pubhc prOperfy aamage� ihereby. <br />` � — <br />S�GNn1u �C Or AOt'L�CnNI <br />�(v �1 �DIb� <br />�.onaess <br />�d�G�- e-�t' __�� o � <br />1.11 V 1 ^ ZIP <br />�V � _ �W �+ <br />1f�6'HONE NUMpER `� ALtERNHtE <br />DAIE � � � � - _ <br />