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APPLICATION FOR RIGHT-OF-WAY USE F"ERMIT <br />. Type or print cleedy with ink <br />PRESS HARD - YOU ARE MAKING COPIES • <br />PlBLIC WOHKS <br />EV�?RETT, WASHINGTON <br />APPLICANT (UNDEFSIGNEDj AtJD FIRM REPRESENTED, IF ANY: <br />PERMI r NO.�,� '�/�' � •� <br />( <br />A'('fHE FOLLOWING LOCATION ! ' ^� i'��� <br />���_ ^� � ^ �C� <br />DRAWING (WORK TO BE DONE) OR TFIREE PLANS ATTACHED: <br />� �-n.u�-��,c.� 0-v��- - ,�lLr t,�Y���' c*� /�P� G� ��tr�� <br />IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTI <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />COMMUNICAilONS <br />ORNNAGE <br />STREEi <br />7�//�So <br />APPROVEDFOR CON TRUCI�ON DnT[ <br />FPPPOVED AS CONSTAUCTED Ont! <br />�I" LIP <br />L 30" _�30" <br />r <br />The undersignetl owner hereby agrees 10 holA and seve harmless <br />Ihe City ol Everett imm any antl all claims lor aamages. costs. <br />enpenses. or causes ol action IhTI may anse �ecause ol mstallabon <br />and mamienance oi Ihe improvemen� or olher ng�4ol-way use <br />hereto apphe0 lor and lurlher agrees lo remove same upun notice <br />Irom ihe Ciiy and to icplTce O��bl¢ Oroperly �Gragetl ihrieby. <br />l / %{�; ' ` . <br />( /" �/ J - � ' <br />SIGNATURE OF qPP�ICAN1 • <br />l/,�'i �:, ; r �, „ , �1--��• <br />nooness <br />� � �, � <br />� <br />`= r :'�� _. >�' � ,.� / .� <br />Cliv LIV <br />`,. "` � L,i � /1 <br />1ELEPIIONE NUAIpE� ALIEANAIE <br />j' '"s _ llJ <br />oa*c --- - — - <br />