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`. <br />ere.en <br />� ' APPLICATION FOR RIGHT-OF-WAY USE <br />Type or print clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />FUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TA BE DONE) OR TIiREE PLANS ATTACHED: <br />,. <br />PERMIT IS VALID FQR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTC�N 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEtVER <br />ORAiNAGE <br />WRTER <br />sT <br />DEPARTMENT APPROVALS <br />LOMM1IUNICNTIUNS <br />TRAFFlC � <br />PLNNNiNG <br />���, ,��.z- �/��/s� <br />APPFOVED F R CONSTRUCTION ontE <br />���__ � ._ �_��'�� <br />P VED AS CON. D DntE <br />CONSTRUCl'ION/AS BUILT <br />PERMIT <br />PERMIT NO. � a"'��� <br />�/`-"--- 'T - l l -(C� <br />ORIVEWAY SECTION <br />� � <br />1'� LIP <br />L30'�� � �L30'� <br />i - r- <br />The un0ersianed owner hereby agrces to hold an0 seve harmless <br />the C�ty of Everetl Irom any and all claims lor damages. costs. <br />e�penses. or causes ol aclion I�aI may arise because ol installalion <br />and mamtenance ol t�e improvemenl or other ng��-pl-way use <br />hcrelo apphed lor and furlher egrees to remove same upon nol¢e <br />Irom me Gty antl to �eplace pubbc orooerty aamaqea Ihereby. <br />. / - �/ /�� <br />' / ' 11. / <br />S�GNFTl1RE Of A�FI�CnNT j <br />y�7���� <br />noaae s <br />�,�v � �i���t' g'd'ez �� 3 <br />�a�'� —��J�`� � ziv <br />TELf�PNONE NUM1IOEGR AUEPNhLE <br />�I - 7 — 0 � <br />nn�e _ _ <br />_ ; <br />`EE 1978 <br />