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everetl <br />Q APPLICATION FOR RIGHT-OF-WAY USE PE.RMIT <br />v Type or prinl cleetly wlih ink <br />PRESS HARD - YOU ARE MAKIPJG COPIES <br />PUBUC WORKS <br />EVERE�TT, N'ASHINGTON .-� FERMIT NO. �l%�'� <br />APPLICANT (UNDERSIGNED) AIJD FIRM REPRESENTED. IF <br />HEREBY APPLIES FOP PERMISSION TO <br />L�( �i: <br />� � ����� �. <br />AT THE FOLLOWING LOCATION �' A'U'� . <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />IIJ nCL0�0'r�1JCE GviTf-ti <br />�%riTC Z It`\��I�GVI� h�C�lil <br />�1 PPRoJCD p�l�N <br />CG�ST`j W� l. �. U� <br />U I�T1= (7 �-!' 4' � � <br />�'�� 1 �.) T� <br />���c c3��c, Dec�_ ,N -r��c- �\t-co�iui or- '���1.30� <br />/1� ��1e ��He or F��i�c-, P��2����' ISSuANcC- vIZ�1(�pp <br />i �cs�2C'T��� '(/0/D� <br />A— -r��t �.r s3�oy c.� � Ic1A�� <br />�o' �11 <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF �HIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION Z59-881 1 <br />24 I�OURS BEFORE CONSTRUCTION <br />OR�INFGE <br />WATER <br />DEPARTMENT APPROVALS <br />COAtMUNiCnTIONS <br />,AAF.�� — <br />PLPNNING <br />STR[ET <br />, <br />� <br />� %.�.' .c� r it �. _:�- <. � �'/ X� <br />A Pfl VEDFOR CONSTRUTTION DnTE ' <br />/ <br />APPROVEO AS GONSTRUCTED DAiE <br />REFERENCECOPY <br />DRIVEWAY SECTION <br />� � <br />+I�� �IP � <br />j_30� "�'�_�'J <br />Tho undersigneE owner nerc6y agrees to hold entl save hermless <br />Ihe City ol Everett Imm any and all claims br Aamnges. cosls. <br />eypenses, o� causes ol ac�ion Ihel mey anse because ol installauon <br />antl memtenence of Ihe �mprovemenl or ol�er ngh4obwey use <br />hCrCiO apOhpO lor antl Iu�iher agr¢es lo r¢mOv¢ Sam¢ upon nulic¢ <br />Iro�� t�e Gty and to repla<e pu�l¢ pro0erly aamage0 1nere�y. <br />� . 1 . . <br />� r. <br />I ; . • j . . <br />t.r f <br />�, �R��D• `��a,�urc� 1 _�:cl nv� — <br />51[yNR�PPI�f.A i . . <br />��.0 � �'CK , IOV 4 ' : <br />noon�ss <br />"7�1,U t.V C pi� : . 4� 7-�Y v <br />��.. • - z,�.•� <br />(0`7 �. -707?i ,..i�S L.-`ll 77i <br />iEl[VHONE NUM�ER AUERNniI <br />1Q�� 1 1 ] S�U _ <br />OAtE �1 <br />l� <br />