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U APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or pnnt cleerly wflh mk <br />PRESS HARD - VOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WqSHINGTON � <br />�;j,/ ,i�!�/nYf �,PERMITN0.1l�pT <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY:� `��'f� �-f�-.-, <br />HEFEBY APPLIES FOR PERMISSION TO <br />� <br />.` , i.., �� � i !' <br />AT THE FOLIOWING LOCATION <br />DRAW�NG (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FpR 60 DAYS <br />� <br />DRIVEWAY SECTION <br />COPY OF THIS APPLICATION TO BE POSTED I --� <br />ON JOBSITE. i" LiP <br />CALL FOR li1lSPECTION 259-881 t 30-1 30" <br />24 HOURS BEFORE CONSTRUCTION <br />5[WER <br />ORAINRGE <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFlC <br />PLANNING <br />APPHOVED FOR CONSTRUCTION DnTE <br />nvNHovto ns coNSTnucreo ,,�,,� — <br />The un0ersigned owner hereby agmes to holC and snvc harmless <br />tnr City ol Everett Irom any antl ell claims lor tlemages. wsts. <br />evpenses, or causes ol atlion �hat r. ay anse because ol inslallalion <br />an0 maNenance p� Ihe �mprovemenl or ot�er rig�pol-way use <br />hereio applied lor antl lurlfier agrees Io rrmove same upon nobcr <br />Irom Ine Gty antl lo rc0�ace pupl¢ o�op^rtv �amnqe� Ineictry <br />% <br />gf NAAU �� PFL� � <br />6 �v=i �i9.�mtr <� <br />�uEr<F7T `�.qr/ �sr� � s� <br />�. <br />ZIP <br />_3ss-.s'� >v <br />TElE1'NONE NUM�CF qLtEFNRiE <br />�? /i �_y� <br />U 1E <br />i--_—.___—___ — ._. --.___— <br />�9/8 <br />