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Ievereq I <br /> �, � APPLICATION FOR RIGHT-OF-WAY USE PERMIT I <br /> Type or print clearly wrth ink . <br /> PRESS HARD - YOU ARE MAKING COPIES <br /> PUBLIC WOFiKS PERMIT NO. �� �� II <br /> IEVERETT,WASHINGTON /� I <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED, IF ANY: <br /> L�Q/r��+�.. 'Jis-•��� <br /> �` � � i <br /> HEREBY APPLIES FOR PERMISSION TO , <br /> I <br /> �c.� I�' <br /> AT THE FOLLOWING LOCATION <br /> ioavZ e�� i �.�1 i <br /> I <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: I <br /> � <br /> I <br /> I <br /> I <br /> w <br /> �"t <br /> ORIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAYS f.----- --� <br /> COPY OF THIS APPLICATION TO BE POSTED i" LIP <br /> I ON JOBSITE. l 30" I � 30 ' <br /> � <br /> CALL FOR INSPECTION 2'Si9-681 1 <br /> 24 HOURS BEFORE CONSTRUCTION The untlersigned owner hereby agrees to holtl anG seve�armless <br /> the Cily ol Everett Irom eny and ell claims lor tlameges, cosls. <br /> eapenses,or causes o�ection ihat mxy arise Decause ol mstaue�ion <br /> and maintenante ol Ihe imOrovement or other ngh4o4way use <br /> he�eto applied �or and Wrlher agrees lo remove same upon nobce <br /> Irom ��e Qty and to replace pubhc DroOerty tlamaged Inereby. <br /> DEPARTMENT APPROVALS <br /> SEW ER COMMUNIC/T�ONS <br /> DAAINFGE _i TRAFFlL � �� �/ �.J� _!- . <br /> -(�. �� lT/LGG({if/ <br /> � I PLANNiNG I SiGNATUAE OF APPUCPNi <br /> C� ���j, ' � . , - <br /> wnr � :..i .� � �,1 /O 3 0 Z 4JCk/✓..z.�. � <br /> nooarss <br /> STREEt� ('', 1" ���/� J fr L O � <br /> i �1V� / � <br /> � /��� 1 ,V�� /� cIP <br /> y ... / ��� � OATE � T CIT� S� —/J �/ <br /> O q N- r <br /> - T@LEPMONE NUMBER A�TEANPTE <br /> - ,.,� � z� !�� �r 9 i s- �r - <br /> pPPR S CONSTRU <br /> DAT[ �AiE <br /> � CON3TRUCTION/AS BUILT �EE 1978 <br />