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��c��„ ppPLICATI�N FOR RIGHT-OF-WAY USE PERMIT <br />� TYPe cr Print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES 79 z3 <br />PUBLIC WORKS PERMIT NO. <br />EVERETT.WASHINGTON /'� -- � ���� �� � ' y�� �� <br />/ � <br />� l.,-��L�li.(.C� ��-L� , � . , .���` <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: � �� � ' <br />�� .. i n�- i f.� <br />HEREBY' APPLIES FOR PERMISSION TO <br />� �� <br />� C. <br />AT THE FOLLOW�NG LOCATION `_ �N � �/� r� ` � /� �7 � i �l� VF' <br />V <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />dN JOBSITE. <br />CpLL. FOR INSPECTION 259-SB 1 9 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPFOVALS <br />`� --\ <br />SEWER GOMI.IUNIC�TIOKS ) <br />pRAMAGE�_ tRAFFlL � / <br />WATER PLANNiNG — <br />� , <br />STnEET <br />� �. i•.� <br />AP .' VE OF CON� � f DnIE <br />qpPROVED AS CONSTNUCTEO DaTE <br />c <br />ORIVEWQY SECT�ON <br />i � <br />i <br />� I" LIP <br />l_30 � � 30 1 <br />IThe undersignod.owner hareby ag�eas,to.holE.aM save harmless <br />Ihe Clty ol Everett Irom any and all clnims lor eameges. cos�s. <br />eapenses. or CTuses o1 U�'ion Ihai may drise because ol installation <br />he CIo apPl CEnlor and �urihe�rroqe e5 toueiooversame`u0o a� obcc <br />Irom Ihe CM1y .lnd lo repldcc pubLC properly OamdgCA �hereby. <br />/�C/ � �� ( < �/ U' .l �/ • <br />SIGNA(iURE Of /PPULANT ` <br />� `c'C Z I/ (.�—/ C I� �� . <br />ADDRF55 <br />� c l � c <br />r ✓ i"' <br />. �-t,� c� t.a . r 1i❑ <br />CiTv � z'.. C _ 1'' � <br />� � i. _ [ I 17 <br />TEIEPMONE NUMB)ER <br />ALiC11NATE <br />� � � �l / CI - <br />..�-�-r-r,.-�.ir�� nnov ___ 19%B <br />