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� � I <br /> � <br /> � � evereM I <br /> li • r � APPLICATION FOR RBGHT-OF-WAY USE PERMIT � <br /> i <br /> Type or print clearly witn mk I <br /> PRESS HAND - YOU ARE MAKING COPIES <br /> �I PUouCwORKs ?ERMITNO.�� � s� <br /> IEVERETT,WASHINGTON � <br /> ' APPLICANT(UNDERSIGNED)AND FIRM REPRESENTED. IF ANY: ""��'��7' �ONST�UGT�OAI I <br /> HEREBY APPIIES FOR PERMISSION TO_ <br /> I,ISC Ex�crrN�, �v_��aG i�ewrwaY �I <br /> -- p3 � o� � I <br /> AT THE FOI LOWING LOCATION_ �/� I <br /> / � <br /> � <br /> I DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: I <br /> II i <br /> I I <br /> i <br /> I <br /> I <br /> I <br /> I <br /> I I <br /> • I <br /> � <br /> � <br /> I <br /> I <br /> � <br /> iORIVEWAY SECTIOk <br /> I <br /> PERMIT AS VALID FOR 60 DAYS L._.�-- -- � I <br /> I <br /> COPY OF THIS APPLICATION TO BE POSTED � i" ua <br /> I ON JOBSITE. �,30'� �-------�.30" <br /> � CALL FOR INSPECTION 259-881 1 <br /> I 24 HOURS BEFORE CONSTRUCTION The undersigned ow�er nereby agrees to hold enG save hermless <br /> ine City ol Everett 'mm any and ell tlaims br damages, costs. <br /> expC�sCs,or ceuse5 0l aclion Ihal may anse beCause o���StallaVon <br /> `I and mamlCnance o` �be impmvemeni or ol�ei ngh4ol�way use <br /> �erelo aPPlied ior an0�urther agrees to remwe same u0on noLce <br /> Irom tne Gry ana �o �ep�ace public prop�rty �amagea ��eieoy. <br /> IDEPARTMENT APPROVALS <br /> � <br /> SE�"/ER COMMUNIUTIONS I <br /> � <br /> iPAFHC \� �I <br /> DPnINPGE V-'�`�' F/C1�NK MRO� , <br /> ! <br /> E'JV PCP ICANI <br /> WA1ER PLANNING I <br /> IS'-iZ I �`1 AJ6 NE <br /> nenA�ss �j <br /> srnEEt �/ A �,.1 �Lt W R . /�LZ� <br /> ;�[/� cirr n ZIP�y <br /> C% / (yS2- b h 88 <br /> pP ROVEO F R NSTRUCTION . � . OATE �3> — Z�2�— <br /> L[LEPnONE NUM�E�� A��EH�p�� I <br /> � 2�9 �� .`/ +i - 2�1- 8� - <br /> onie onie � <br /> AP AS GO TED I <br /> CONSTRUCTION/AS BUILT �ce 1978 <br />