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u <br />A <br />—� 7ype or pnnt Cleerty wit� inA <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBL'IC WORKS <br />EVERETT.WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPFESENTED, IF ANY: <br />HEREDY APPLIES FOR PERMISSION <br />AT THE FOLLOWING <br />DRAWING (WORK TO BE DONE) OR <br />r� <br />7� <br />PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-861 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />pi�nnOVED AS CONSTRUCTED onie <br />PERMIT NO. � � <br />DRIVEWAY SECTION <br />j I'� LIP � <br />30" �_30„ <br />The undersignetl owner hereby agrees to I+oltl nnE seve harmless <br />Ihe City ol Eveirtt imm any anE all claims lor damages. cosis. <br />e.penses. or causes ol aclion Ihat may arise �ecause ol mstallatron <br />antl ma��tenance ol Ihe imOrovement o� otiicr righl-ol-way use <br />nereto applie0 �or ano luriner aqrees to remove same uvon nobcP. <br />Irom Ihe C�ty and lo replace pu�l¢ p�operty damaged tnereDy. <br />X <br />SiGN nE � /OP�iCANt <br />Zf'D 3 � ��o,._� � <br />nooaess <br />-#C�`i_�""Y�`�n�'(�lA, %�223 <br />G LIP <br />�,� � -'13i',' <br />TELE�HONE NWdOEN ALIEPNAIE <br />�� �9 <br />DATE <br />—(�I e r, � — <br />t9; 3 <br />