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everen <br />e <br />APPLICATION FOR RIGHT-OF-WA� USE PERMIT <br />Type or prin� cicerly with ink <br />PRESS HARD - YOU ARE MAKING COPIES • <br />PERMIT NO.' �' � '. � <br />PUBLIC WOHKS <br />EVERETT. WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION <br />� / . . _ . _� j . <br />AT THE FOLLOWING IOCATION ' � �� <br />!a/' � <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: � � <br />�'J �, � o-,,��� -�tvv ��s�-r.� o-� r',� c� �,-L��-o-�-� <br />��- �- _ <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />p;J JOBSITE. <br />CpLL FOR INSPECTION 259-861 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEKE� <br />pqqINRGE <br />WATEN <br />STREET <br />DEPARTMENT APPROVALS <br />LOMM1NNIGAilONS <br />Tf1AFRC <br />p�qNNING <br />7/ii /So <br />qPPROVED FOP CON TFUGTION <br />onie <br />D�1E <br />APPROVEDASCONSTAJCTED <br />DRIVEWQY SECTION <br />1 I" LIP <br />L 30" � 30 <br />i- <br />The undersigned owner hereby egrees to hnitl antl save harmless <br />Ihe Ciry ol Eve�el� Imm any antl all claims lor tlamages. costs. <br />eapenses. ni causes ol action Ihat may anse because ol mstailaho� <br />and ma�nienance ol Ihe improveme�d or other ngM-o�-w�Y ��se <br />nerelo apphetl �o� an� luriher agrees to remeve smme upon nobcc <br />Irom Ihe Ciiy a�d lo �ep�ace publ¢ prope�ty tlamaged t��e�eby. <br />, /� <br />/t / -'�/' . .� "� <br />SIGN/ iIIRE OF AVPL�CAN� �.'�� <br />l,,'� rJ � .. , ,- , . <br />AOO�CS�y—� �� ; <br />" � ��/r . f �/� I ,+ � �l — <br />� 2�P <br />Crtv <br />� <br />: ��_�.-_,c, <br />iEIEPHONE NUMBER A�����A�� <br />�j - '% ' ��� _ . <br />oniE <br />S <br /><<< - ------ <br />