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everetl APP�ICATION FOR RIG�IT-OF-WAY USE PERMIT <br />� TYPe or Print clearly witn mk <br />PRESS IiARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. � 2 <br />EVERETT,WASH��NGTON <br />� � - �-.-�: �.�.% <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: n , � n,� • <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWIIVG LOCATION 3 7'� 4 ����""�� <br />DRAWING (WORK TO BE DONE) OR THREE S�LANS ATTACHED: <br />4�ERMIT iS VALID FOf� 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL POR INSPECTION 259-681 1 <br />24 HUURS BEFORE CONSTRUCTION <br />$EWEN <br />DEPAR7MENT APPROVALS <br />COMMUNICRTIONS <br />DRAINAGE 'I� �U �� J' � �`�A�^� <br />U J � � <br />W�TEP ` VL` I G <br />IJf.1 p! ���� <br />StREET �/1 • <br />� �.�_._. .... .// . n <br />� I �'AYY� <br />ii:ll� ir <br />�� ' <br />UrTION/AS BUILT <br />DRIVEWAY SECTION <br />�I'� UP � <br />� 30" I �30" <br />T�o un0ersigned owner hereby egrees to �oIC anE seve hermless <br />Ihe C1ty ol Evereti irom eny an0 all claims lor Oamages. cosls, <br />e�0enses, or cause9 0l aclion I�at may a�lse becausb of mslallabon <br />an0 mamlenance ol Ihe �mprovement or ot�er nqhl�obway use <br />hereto app�red �or anp lurt�er agiees to �emove same upon nolice <br />irom tne Ctly antl to �eplace pu0lic���%� �0 t� <br />� / � <br />9GNAiURE Jf <FPLIUN <br />,�Z/� �I'SJ -d4:L <br />nooacss <br />UC� �'c <br />CIiY ZIP <br />3s 3� t331 <br />iELEPNONE NUM�EH I.�IERNAiE <br />