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everen <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clexrly wlth ink <br />PRESS HAHD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: �`/_I/'�/ �- �L • / /�-/� -�� <br />/ <br />HEREBY APPLIES FOR PERMISSIO�' TO �A(/� �.��' �i�ECT ���ti�C%� <br />AT THE FOLLOWING LOCATION � L/Q� �C�C ���G��/E�— ��C�G��T <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />,�aC��rE//E/E' <br />� Oi� �'�C �frf/�Eii �o �fN� E a� ' . <br />� Oi= a �/�`� � GE�/�� �?� f <br />� r�sr ;� �S �- �' �cN� y� '�%;' <br />rERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CQLL FOR INSPE�TION 259-�81 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SLwEn <br />Df1AINRGE <br />s, <br />DEPARTMENT APPROVALS <br />COMMUNiCAii045 <br />TFAFFIC <br />P�ANNiNG <br />i,i�rivoveo For� coNsn�uciioN - � �,.,��. - <br />APPHO�@Dr15CClN51RUGTLD � —� - ��•^'!�— � <br />DRIVEWAY SECTION <br />� � <br />I'� LIP <br />30" 1 � � 30" I <br />I '1 <br />The undersiqnetl owner hereby agrees to holtl and save harmless <br />Ihe Cily ol Everell Irom eny and all clnims lor tlamages. cosls. <br />expenses. or causes ol aclion Ihat may nri,e because ol inslatlalion <br />antl manlenance ol Ilie impmvamen� or oiher nghbo���+,y usc <br />hrie�o apVlicd Ior ani) furlhrr aprrr: :� iemove same npon noLce <br />hom IhC Cil)' dntf In ro{'Iaco t":�Uhc i�ro��,rrh' tl�vnd9i u InrirM1c <br />� �%� � �c�%�Z�z! - <br />S�GNATUPE 0� F� iCANI <br />�C7�T 2 ��.F'/t/cln/ �ci _ <br />nonAess <br />,��E— ST���S u�/1 y�.�SF� <br />crtr br <br />�a �/-9l 3 � _ .�S-�-c� �.�5`� <br />�ELEPHONE NUMOEP A�i[RNnrC <br />1! <br />