Laserfiche WebLink
f� Y"i/ �iG 2 Go <br />everen <br />� APPLICATION FOR RIGHT-OF-WAY USE P�RMIT <br />Type or print clearly witn mk <br />� PRESS HARD - YOU ARE MAKING COPIES <br />PU�LIC WORKS <br />EVERETT,WqSHINGTON <br />APPLICANT (UNDERCIGNED) AND FIRM REPRESENTED, IF ANY: <br />FIEREBY A�PLIES FOR PERMISSION TO <br />PERMIT NO.�/J'� <br />AT THE FOLLOWING LOCATION 5505-.f�o�,Fe-� llav c�i. ��� �,�._ �Q20.� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE PQSTED <br />ON JOBSITE. <br />CALL FOR IMSPECTI�PI 259-881 1 <br />24 ii0UR5 BEFORE CONSTRUCTION <br />SEWER <br />ORnINAGG <br />WATER <br />STPEET <br />DEPARTMENT APPROVALS <br />GOMMUNiC/+ti0N5 <br />TRAFFlC <br />FLqNt11NG <br />// (�i <br />APPRr /D�CO S�CT107N � _ 2oqiE�/ <br />� <br />� 5 /}U6 �( <br />l <br />AP D AS C STFUCTED pAiE <br />CONSTRUCTION;AS BUII:I' <br />DRIVEWAY SECTION <br />jl" LIP <br />L.30" � � 30" <br />i <br />The undersigned owncr here0y agrecs lo holG nntl sovc harmless <br />Il�e City ol Eve�etl Irnm any and nll clair��s lor damages, cosis <br />exp¢nses. or causes ol action Ihat may ari;e bvwusn nl inslallalion <br />antl mmntenpnce ol Ine �mprovenenl ar uthm ngh4obway �rse <br />�ercto apPheG lor antl lurlher ayrMs �n remwe snmc oVon nobce <br />Irom thc G�y and to replace publ¢ property tlamagetl n�ereby, <br />�� �� <br />SILNAiURE OF APP�ICBNI <br />'d�-= i4»C �`l�iG <br />/OORE55 <br />��Qici'� �. �V � <br />f,I1V ZIP <br />c�s�; i:%-i'i is� �a`IS <br />iELEPHO E NdMOE E � <br />� AL � F1Nrl- E <br />OAIE � �� - <br />