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everett <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Typc or pnnt clearly wtlh ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />i PUBLIC WORKS �/�y.y <br />EVERETT. WASHINGTON PERMIT NO._J �— <br />� APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY�. S/1�•QSYAO x' G(,�L� ��iN�S /NG <br />IHEREBY APPLIES FOR PERMISSION TO �BNSTilUGT �.3 / /%t/!/�LtJ�f� <br />� <br />' . / � i !'. �, � . <br />I AT THE FOLLOWING LOCATION /"-�_ __ _ — <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />�'PJ�.'' �-'�-^ -�Z�C�/�p��1�-�� <br />F�EHMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTIUN 259-88 7 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SRtiEP <br />ennrtlAGE <br />DEPARTMENT APPROVALS <br />couMUwCntiOrvS <br />iRNfiIC <br />��v4TEfi vinNNMG -- <br />�rF«r <br />-- �y ' y%'�.� <br />� �/J//���/ <br />aPP VED F09 C N UC � It�Ni // � ���� <br />v <br />�APPFOVED AG CONSTRUGTED OatE <br />DRIVEWAY SECTION <br />�� f I" LIP <br />�., 30 ►�"'—_ _—•1•3�"1 <br />The undersigned owner horeby agree5 to holo and save harmless <br />Rv� City ol Everett Irom eny ana nu claims lor �amnges. cosis. <br />rvpunses. or cnuses ol aClion IM1aI may ense bcr.ause ol ins�allapo� <br />anif mainlennnce ol I�e imprmempn� or olhei ngM-ol�way use <br />heic�o appLed lo� antl lur�her agrees lo iemooe Same u0on nol¢e <br />Im�n tl�r Cdv an� lu roo���e public preoerly eamaged iM1creby. <br />>� <br />/ �_ <br />��_������� <br />.I�NAIIIRC OF N`PLIC�N1 <br />�o�� `� <br />_ f�i /(��� dv �ui� �i�a.�.3 <br />UtY Ilr <br />�-�7 `- �,Y�y <br />lEl L IY��O4�C tl i61�Eli ALl[ONPiC <br />=/ `3��9 - - <br />pAl[ <br />r,�, u;._; �cecor-v �EE <br />_.____ ._�.�sa,m�;a <br />�J%B <br />�� <br />