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�. everelt <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />� Type or pnN Ckerly with mk <br />�� PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WONKS <br />EVERETT WASHINGTON <br />�f / r �� ��� . � • f <br />�: ., <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY:.�..� <br />HEREBY APPLIES FOR PERMISSION TO— <br />AT THE FOLLOWING LOCATION � <br />r /! <br />i - <br />��' / ' �ir". �-. <br />ORAWING (WORK TO BE DONE) OR THREE �LANS ATTACHED: <br />� ��a� <br />nCe E�nS�N eetr n <br />�. , y� s u .�.e e�- �� ee.� <br />PERMIT NO. `! " � <br />5 <br />m ('er�-c�.�... �� ..,�ci �� PIA�ti 3 <br />c�e.�a:�l� e i-�. <br />Z , C.. C� � `o � � ��a, 11 c � � � � ,,..� o -4— <br />�f'�v2wC� -�.o be ���e 1-C- <br />3, co� �e�.-�.. � � � r�.� �i ��e �-�-� � e �w-��,.�.1 <br />c.! <br />C {� . ,�,,u.s�-- � � � ,.. �. <br />/ \ r j� `� � � �..v.�\--� <br />L.� (� p r�l A rt O T Gl.Y� <br />� 1 nct,.� e� <br />,� �� � <br />�n � �,-..b ��� v2o w <br />,,.�..� � 1�,�� e w� �� �z 0 w ��,,. 2 <br />l�� ele�. o �- .Q d ,11 <br />S�: _T .�;�� `F-►�� �l��b'�'� � <br />w,w5 � � � le� �l U- � '� "� <br />, <br />Qd,�,c. B�. /�GLJ <br />Y ��i�� _ <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEWER <br />ORRiNNGE <br />�/ � <br />W4��:� 1�/��fr % <br />�;+ � <br />STREET J <br />LOMMUNiCAT�ONS <br />TRRffIC <br />PLANNING <br />r � `� <br />` f/ <br />APPROVED fOfi CONSTRUCTION DnTE <br />qPPROVGD Ati CONSTRUC7ED CATE <br />.. . �,'�. I; .. , � � IOf�.I r�:-.��I IFSTED <br />��,3-- 8�/ <br />�y - 3_�/ i eNV RD�EsS Wsc� <br />DRIVEWAY SECTION <br />�— ji„ LIP <br />I� 30'� _�_ 30';J <br />The unde.signe0 owner hereby agrees to hold entl save harmless <br />Ihe Cily ol Everetl Irom nny an0 all claims lor damages. wsls. <br />CtpCn5Q5. 01 COu5e5 OI BCtion Ih.11 mly 8ri5e bCCBuSC LI in5lallphon <br />and mamlenflnce ol Ihe impuvemenl or otner nghl-ol-way use <br />�erMo apphed lor antl �utl�er dgrees b remove same upon notme <br />Imm I�e Cily and to �eO�Tce pu�hc p��{��'��4 �amaged ihereby, <br />�i C ^�/� <br />���„�,�o ,diy �•� ,- �rcf!s <br />/^ ._� <br />� !� /I:l.i T-1 <br />$IGNAIURE OF APCLIGANT <br />%/ �/G �.�/�F'or /j. L <br />PDO�C55 ! � P <br />�^!'F/(/T/ l��fl'l �C_,rcG'J..J,61 <br />arr $1� <br />'�_ �' '/� :/ �' ,/ 7/�✓ <br />iELE�'MONE NIIMpER / Pl1EPNnlF I <br />ilii.�' l � / %�? ._ <br />pATE <br />1978 <br />