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3 <br />N_ _ . <br />.� <br />dFe1t <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />� Typs or print cleaAy wilh mk <br />�� PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS �. . <br />EVERETT, WASHIN�iTON PERMIT NO.�,�� � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION ����� � �,IOU� �� <br />DRAWING (WORK TO BE DONE) OR l'HREE PLAkS ATTACHED: <br />PF_RMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR eNSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />DEPARTMENT APPROVALS <br />COMMUNICnLIONS <br />iRPLfIC <br />PL�NNMG <br />S1REE� <br />_____� � � � /��_� <br />APPRO CONS H C IO�II��F- N -- <br />APPR S�NST UCTED �/��/�v <br />CONSTRUCTIO�I//1S HUILT <br />ORIVEWAY SECTION <br />j 1'� LIP <br />� <br />�30'� �30,� <br />The under5igneU owner hereby ng�ees to �oltl end seve harmless <br />Ihe Cdy ol Everell Irom any ontl all cleims lor Gamayes. costs. <br />evpenses. o� causes ol ac0on ihat may anse because ol installabon <br />and mTintenance OI Ihe unpmvemenl or cihrr n3hbol-way use <br />lereto npP�ie� for and lurrt�ci nqrces lo remove same �mon nobce <br />Irom I�c Ctly an0 to mplan± publ�c p�op^rly aamagetl IDereby. <br />�' r/ <br />��./.�i��- � i C�ucfv<- /�- <br />SIGNAiIJR[ Oi qPPL�QNI <br />L- v c r � 7%� rfA� d3 <br />tCLEPMONE NUMOER PtiLRNNT[ <br />3 s-3 — y z iF' <br />DA1[ <br />7—a9— �'Q <br />,s�e <br />