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� <br />everett <br />Q APPLICATION FO HT-OF-WA�Y USE <br />vType or priN clearly wilh mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT,WASHINGTON <br />APPLICANT (UN�ERSIGNED) AND FI M REP SENTED, IF ANY:_ <br />• ��-ua <br />HEREBY APPLIES FOR PERMISSION'J _ �� � �C �¢ <br />1 AT THE FOLLOWING LOCATION �/ /� _�� � n� �v C <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />� �{ <br />..2.J ' <br />nacw� <br />�per�y <br />✓ c. ' <br />,ha C.13. <br />PERMIT IS VALID FOfR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INISPECTION 259-681 i <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />ORAINAGE <br />DEPARTMtNT APPROVALS <br />COMMUNILAI IONS <br />iNRFiiC <br />a�nNr�in�c <br />f /7T'L�— ��/ZO��'� <br />APPROV D FO ONSTRUCTION � pqt'� E <br />FPPROVEO AS C STRI C'i F�' � E �� <br />PERMIT <br />PERMIT NO. )s+ 3 _ <br />p�rF° �-z� ��a.- <br />Co..cl,�-�o,..� <br />�rT�0.� NOf�10v� Oi "','NG <br />ci��.,�wa w��1.�., -Fl,� R qW4- <br />p� Wn� ��nb� bt �wJl� <br />.'�, �Jc��cwo7 w.aF bc ievci <br />wi1�, ��1���:nryry11 edr�e o:- <br />foaci..�n� a.�- �+o�e(-}�� \�.,e <br />3,1Hm,l�.li TyP� I�C �G'�3 �.h <br />bO�TOy.� O� �f�Je <br />�/�/ 1 SioPe <br />P.nW GoNHI'C� Qp `e / <br />�1=TIN <br />�� � �' cor�. P,-P� d <br />\ <br />� <br />% <br />�.�V1C �x1��IN` 5}brw� �fw..� <br />I�he e�os�� �j -ti�c lo� �S <br />w ���.io..lc c1rA�:. wl�,��. <br />�e rall w..,�} be v�nw:.�.:n/��, <br />L\ � �(@�JC0..��a.� ff�N�2rcY <br />or �e(�a:� � o�N <br />�Qlw� 6�G C6L�n5r� I S` �� <br />r�s�o.ns,h���� o� i-l.� <br />(Jw�er�-' o,.— e/ <br />Signature of Applicant <br />DRIVEWAY SECTION <br />� I <br />�� j I�� �IP / <br />�„ 30„ �, I 30" <br />�t <br />The u^tlersipned owner nereby ngrees to holtl ena snve hnrmless <br />the City ol Everell irom any xna ail claims ior tlamnges. cosls. <br />evpenses, or causes o� ection Innt rnay arise �ecause ol mslnllnpon <br />Tnd mainien0nce oi Ihe impro�ement or other nghl-ol�way use <br />hereto aOPIieO lor ane I�rihei agrces ic �emwe same'dpnn noLce <br />irom t�c Cily antl lo ieplace puhl¢ property aamayta InereCy. <br />�- //' % l/" 'G�G ;�rti! <br />SiGNATU��E Of Av i�N�i <br />,S � , .�O ...3 " �'/%G� <br />noo���� i""�� 9/� ��� <br />CI1T jIP <br />a s�-i��,r <br />iCLEV�MpEN �//�^T`/�� �LIERNAiQ <br />�LI / n <br />