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1 <br />� <br />eveien <br />� APPLICATION FOR RIGFIT-OF-WAY USE PERMIT . <br />Type or print clearly with �nk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS �- <br />EVERETT, WASHINGTON PERMIT NO. �'n �7 <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF A�V: <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION � � �� �� / // ��OG/(.Cr �� <br />DRI:WING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />A <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-891 1 <br />24 HC�URS BEFORE CONSTRUCTION <br />SEWER <br />DRAINRGE <br />DEPARTMENT APPROVALS <br />COMMUMCAt�ONS <br />WATER I 'I \� •l�F� PLANNINO' .` <br />1` I <br />r � <br />STREET <br />� � <br />C �; ., ,-7` �- r So <br />APPROVED F fiON'� f 'EIpN.' �! ': 1 I V 0 T[ <br />� . , . �, ��:� <br />,-,i»�nvro nc7�nN�;*nuc�rn n�.,i <br />DRIVEWAY SECTION <br />� � <br />+I'� LIP � <br />L30" �, �T 30"� <br />i- <br />The untlersigned ownor hereby egrees lo hold entl seve harmless <br />I�o Ciry ol Everett Imm eny antl ell c:eims lor damages, costs. <br />erVenses. or cnuses ol aclion Ihat may anse because ol inslallabon <br />an0 maiNenTnce ol Ihe improvement or other ngh4ol-way use <br />hereto appLed �or an0 �uriher agrees lo remove same upon notme <br />Irom Ihe C�Iy a�tl Io reO�aCe pu�l�C pmpertY Oamagetl Ibereby. <br />�.s,/��---- 'ii c��:e�,.(,,,,. .0�, <br />SIGNaTURE O� APGLICnNI <br />.�7/T/ � � y <br />/= „ �: ,- � 71' >�� v� <br />1ELEPNONE NUM�ER qLiEPNFiC <br />5 <br />p i j— �'C i�'_ <br />��n.� _ — —_ _ <br />