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everen _------ ----- <br />Q APPLICATION FOR I�tGHT-OF-WAY USE _ RMIT <br />`� Type or print cleerly with mk <br />PRESS HARD - Y011AREiv1AKiNG'COPTES"—'— <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIFM REPRESENTED, IF ANY: <br />� /� / <br />HEREBY APPLIES FOR PERMISSION TO LL( / <br />PERMIT NO. � � <br />ATTHEFOLLOWINGLOCATION �J �'" W U/1 / I l�� 1/I� - �.--//E'/j(''C/ �/%I. <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS �ALID FOii 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 2s9-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />sewen <br />ORAiNFGE <br />WRiER <br />DEPARTMENT APPFiOVALS <br />COMMIINICATIONS <br />TRAFi1C <br />PLANNING <br />CONSTRUCTION/AS BUILT <br />.: ... ....... . <br />i�..��� <br />DRIVEWAY SECTION <br />� � <br />I'� LIP <br />L�;�„ +ao"� <br />The undersigned owner horeby egrees to ho10 and save �armlese <br />in? C�ty ol Everell Irom any and ell clalms lor Eemeges. cosis. <br />CHpCO5C5. Of CdU525 OI AC�I011lhdi Tqy BIISC �PC605E OI iO5I211d�i0O <br />antl main�enance ol Ihe �mprovement or olher ngnl�ol-wxy use <br />hereto apphetl br anA lurihc� Agrees �o remove same upon nobce <br />Iwm Ihe Crty and Io re0�atc pubbc proDerty tlamageC Inereby. <br />-�(�/�/ fi/\ � ��/��.J <br />�SIGNATUfiE Oi AFP�IC/Ni <br />h�7/ � Cc/�efl � /�� -C� <br />nooness <br />�.=v��t�� �.i/�s�. i6"�o3 <br />dTV LIP <br />a.� -:� y� �� � s,� 3 �� � <br />LEIEPNONE NUMBEP qL1ERNAiE <br />/!!�/z./ �. / %�"7 <br />on*[ - <br />`EE 7978 <br />