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� <br />II <br />. <br />� <br />everett <br />� APPLICATIQN FO HT-OF-WAY USE PERMIT <br />Type or prinl clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS �ERMIT NO. �� �' <br />EVERETT. WASHINGTON <br />APPUCANT (UNDERSIGN jDl AND PI M REP SENTED, iF ANY�. <br />co r�4 <br />HEFEBY APPLIES FOR PERMISSION TO �� ��� �Q <br />�___ <br />, — 5/l4-S� 3"� Q�� <br />� AT THE FOLLC�N'ING LOCATION <br />DRAWIN�i (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />�of <br />Y �� <br />h�-_�-.� � a <br />�yryM f�JL�Jf <br />\ Ov��f�V C (O [f� <br />�Q� r4 C•l� <br />� PERMIT IS VALID PAR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL POR INSPECTION 259-881 7 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />OnqINNGE <br />WATER <br />s,,,E�. <br />� <br />DEPARTMENT APPROVALS <br />COMMUNiCNTIONS <br />PLANNING <br />Ed�'r� tf ,.��.- <br />`OV�C���1ON 7 <br />��1 �1 <br />�.,1�0.T �Of'l'1an O� �1+G <br />q/r�vCww7 w���.�n ��C {Z.c1� <br />Of WCy JNhb} �OC /JwJt� <br />/ � <br />."l, ZJ��vtwory vw�ef be \eve� <br />wi�l-I+ e.�1151-�n, ad5a o 1"`v�e <br />rooci,.�a,� a..!- �.oPe��.� <br />3.1v�•�:�.It TIyP< 1•G �G�3 wk <br />boF/}�ow. oF c��:�a_...,1 slo�e. <br />n„J� �o..nec{- d-o e�l�a��.,a <br />C�S .y� to' toH�. P,-P� <br />� �.'Tl�e t,.��4i� sto�.,.. �ra,.. <br />t,r< «055, �q� t�,� ,ak ;, <br />� a pr.�w:c dra�:, w�.,..1,. <br />1 <br />\r �\1 w...�� bc vv.w:..�an�� <br />o, � �eloca��o.-. rcSN,.c��S! <br />or �e�a:� � o��y <br />I .I <br />�iQM+R�C C�NSf ISl 1�"� <br />' (tSpO✓�S.h�I�T o{' �� <br />� 1' 1 � <br />/ Pro�eri-f o�.,- e/ <br />M • <br />Signnture oP Applicant <br />DR�VEWAY SECTION <br />jl" LIP <br />�3Q'� �30 <br />.•—. �. <br />Thc unEersigneG ow�^r �ereDy egrees Io holtl nnd seve hermless <br />1he City ol Evemtl irom any an0 nll claims br damages. msls. <br />evpenses. or ceuscs ol action lM1at mny. nse �ecause ol inslallalwn <br />an0 mai�tenence of N^ �mp�ovement or Mhcr riqni-obwny use <br />herelo applied lo� nn� lurlher agmes lo remove same upo� nul¢e <br />Irom t0e C�ty ana lo �eplace pubhc pro0erty aamaged the�eby. <br />' _� 3 <br />/ �� <br />�j <br />J�.%�����— <br />� <br />� 9�2as <br />, ��,. a s�-���.s- <br />t[LEPMONE NUMpEa �LIERNPLE <br />!�/ �'�T,� /9�/ - <br />DA�E <br />CONSTRUCTION/AS [3UILT <br />