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!V!f!„ <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />`� Type or print clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />'cVERETT. WASHINGTON <br />PERMIT NO. � � � <br />APPUCANT (UNDERSIGNED) AND FIRIA REPR65ENTcD, IF ANV: ✓I�IJ� l7 �� C l�p ��'—_T7' <br />tiEREBY APPLIES FOR PERMISSION TO G Q�-+ =�T+� v-J � r ��N �' D/� <br />AT THE FOLLOWING LOCATION 4" /�D `� ��JT�J PL- � C�v � �� �� Q�'yC E. I—�� O. <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />QN JOBSITE. <br />> CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />ORRINAGC <br />WATLR <br />DEPARTMENT APPROVALS <br />COAndUMCnLiONS <br />TRAiFIC <br />❑IANN�NG <br />. �� ��` ��' J� + J <br />� A PFOVED fOR CC STRUCT�ON ��n�F <br />,���/ --. �� <br />v[o�ns c 5rau� on+e <br />,� �.'.-ii:!':;I;Uii.._-.I�ll-' <br />DRIVEWAY SECTION <br />j I" LIP <br />I 30'�-� _�_30" <br />r <br />The undeBigned owcer hereby egrees lo hola entl seve bermless <br />��e C�ty ol Everett Irom any an0 all tlaims br Cameges, cosis. <br />e.nenses. or causes ol achon Inpt mny arise �ecause ol instaiinbon <br />Tnd RiainlentnC¢ oi IhC impmvemcnl Or Other ng�I�oLwny use <br />�cicto a001ie� lor and Im1�ar agrees b remove same upo� nolice <br />bom Ine C�ty antl ro�eplace p�OLc p�ope�ry damage� themby. <br />�� � / ' / C/✓� �jn_✓ --- <br />$IGNATURE OF Av�uG�nN�l �� �/ <br />GtJ/(� Vr 5 �G/ '� <br />ADDNE55 <br />�pV � � ��'i2 U �7 <br />c�r� tJ J�" �� �� zii• <br />� C�EP��ONC NUMIIEP FL1[RNRiC <br />onie <br />__. - _. __ .__ ___ _-1978 <br />