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everetl <br />"� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or prinl clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESEN?ED, IF ANY: <br />i % (.� . , : r . � <br />HEREBY APPLIES FOR PERMISSION TO <br />PERMIT NO. z3 <br />�� � �_� <br />e <br />AT THE FOLLOWING LOCATION "��" � — ' ' <br />�� W i /��% �i r i�j r j-,, r� V� <br />DRAWING (WORK TO BE DONE) OR TH�ANS ATTACHED: <br />��� � -��- <br />Ex�s-I.:.�. (,�on�l�� nAo ,,-tz ��\ <br />� <br />0 <br />11�,Pac' � � �� COVO..N� <br />,� k'o�v <br />C��''° <br />�,1���, - y�P`'�I �� J �� -c7 � � � <br />PERMIT IS VALID POR 60 DAYS <br />COPY OF THIS APPLICAT{ON TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DPAINAGE <br />ST�EET <br />ORIVEWAY SECTION <br />f I'� LIP <br />� <br />� 30 � 30,� <br />The untler5igneE ownfr �e�Eby agrCCs,to �oltl antl save M1armless <br />Ihe Ciry ol Everell Imm any antl all clnims lor damne�es, costs. <br />eapenses. or causes o� action Ihel may anse because of mslallntion <br />antl maintenanre ol Ihc improvemenl o� otM1rr nght-ol-way usr <br />hae�a aVPbed br and luillier .tgrees lo remove same upon nobce <br />Iroin �he Ciiy dntl to �epinCe pubLc ; rope��y damag�tl IherCOy. <br />DEPARTMENT APPROVALS �� � /��J�� �/ A��T� <br />N r.�' <br />COh1MUNIC/ 110N5 <br />TRAFfIC <br />PLANNING <br />APPfiOVEO FOR CONSTRUCTION oAr� <br />qPPROVEU A$ CONSTRUCTED �'��� <br />/� <br />SIGNnTURE OF FPPLICFNT C_ � . <br />. ' c ; .'j i� �-• 'i <br />AODRE55 � �— <br />� {-+, � <br />cirv � . . zir <br />_ �l-) ,;, �� <br />LElEPN08E NUM1�O[�� . Al1ERN�iC <br />�����'/�� � - ._ <br />DniE • <br />