Laserfiche WebLink
everen <br />APPLICATION FOR RIGHT-OF-WAY I <br />e <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />Type or print clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />APPIICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO <br />AT THE FOLLOWING LOCATION _ v� � <br />C i <br />DRAWING (WORK TO BE DONEa OR THREE PLANS ATTACHED: <br />IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO eE NUs i e <br />ON JOBSI7E. <br />CALL FOR INSPC-CTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />� -__�� <br />$EWEB WhIMUNICAilONS ) <br />ORAINAGE TRAFfIC �-- <br />\4ATER P! ANNIN� <br />) "_ <br />STn[ET <br />__��� � �/� , . <br />qp� yE OfiCONSTRU � � OAtE <br />qpPFOVED AS CONSTRUCTED 0^�� <br />PERMIT NO. 79 �"3 <br />C`�,.,�f: <br />�� j I" LIP — <br />� 30�� _�_30 �J <br />-i <br />The unaersiBnetl.owner �ureby.qgreas,to.4oltl.anA snre harmless <br />tl�e City ol Everelt Irom any an0 ali cleims lor tlameges, costs. <br />expenses, or eausos of aztion ihai may arise bewuse ol msiallation <br />dntl main�enn�ce OI Ih¢ imOrOVCmPnI Or olher nghl-o�-way use <br />hereto appiiCO lor and lurlher agrees Io mmooe same upon nobce <br />�wm thn Ciry ana to �eplace pWbc piopci�Y aamaged tnereby. <br />�, ��,'�'=�! cP���'�� ' <br />SIGN�TURE OV APPLICRNI <br />/ ��[ � f � /�.�1 <br />2. (Ci.C.�t. l <br />aouaess <br />c. i ' <br />%��� -i i �. : <br />CITY , ZIP <br />r <br />,' �.! [ Ili I ''C C If. <br />TELEPHONE NUMBEP ALTET�NPiE . <br />�-]�l-J�� <br />