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,# �v/�ip2� <br />everetl <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or prin� Cleady wi�h mk <br />� PR[SS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERAIIT NO. `2i//v� <br />/ <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO <br />ATTHEFOLLOWWGLOCATION_S✓!OS'���OCTE+�G���B/� ��lT��f�l��_ /cQZO.� <br />DRAiNING (WORK TO BE DONE) OR THREC PLANS ATTACHED: <br />PERMIT IS VALID FC�� �k3� DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOF� INSPECTI(3N 259-8t81 i <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />ORAINAGE <br />DEPARTMENT APPROVALS <br />COAIMOMC/ TIONS <br />WAiEN PIANNiqG <br />5`RflE� <br />� �T' 4-Z-S'� <br />APPF DFO CO STRUCTION 041E <br />DRIVEWAY SECTIUN <br />� � <br />1" LIP � <br />L30�___ �30" <br />i- <br />The un0ersi�netl ownor �ereby agmes Io �oIE end snve harmless <br />ihe Ciry ol E��eret� 4om any antl all claims lor tlamage;, cosls. <br />espenses. or causes ol aetion Ihni may anse because ol inslallation <br />an0 mpmlenance of Ir urovemenl or olhm righi-obway use <br />�errin ,nn���d io� a�e agices to remove same upon noi¢e <br />L•cni IM1e City dn0 1 :e pubbc. prppeity tlamaye� Inmrby. <br />�__ �,6r�� <br />�1J� <br />SIGNhIIIRE OF AP✓JCANI <br />0� � a,� �`7�1 L <br />�/oness (� <br />( JtliCC� �L�V � <br />Ciiv Ii�' <br />,�s� r�z�_� -{�sa aa�iS <br />iE�tVNO ENUMOF nL1E�Nn1E <br />`>_ /iU� v'� _�.<_�Yl_�/ <br />