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everen <br />� APPLICATION F�OR RIGHT-OF-WAY USE FERMIT <br />Type or priM cleady with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS � <br />EVERETT, WASHINGTON PERMIT NO. � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTE�, IF ANY: ^" '� ��L � <br />' �r � .e � �.. � _ � � � .�"t..�t . _ 6 �� <br />HEREBY APPLIES FOR PERMISSION TO_,�, <br />AT THE FOLLOWING LOCATION /S3 '!- ��" �sL.r T <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />r <br />v <br />\ <br />w�����-f <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CAS.L FOR INSPECTION 2.,4r9-861 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />ORniNNGE <br />WqTER <br />s*aeeT <br />DEPARTMENT APPROVALS <br />COMMUNiCnt10N5 <br />rinr�r�irvr, <br />� � <br />T— / )�/S���O _ <br />APPROVE FO CONSiRY TION � � A�r� <br />�. / � � I � �� il A...�_ � ( � � �I � " �� <br />DRIVEWAY SECTION <br />I T� <br />I'� LIP /� <br />3p � _�_3�1 <br />The un0ersia•�ed owner �ereGy egrees to hold and save �armless <br />Ihe City ol Everell Imm any anE all claim! ioi da•�•°gxs. msis. <br />eRpenses, or causes o� aetion Ih�1 may a�iee because oi bslalletion <br />anC mantenance ol Ihe impwvement o� ot�er righl-o��way use <br />nereto apPbed br ena lurther agrees lo �emove same upoo noiice <br />Irom Ihe Ctly ana tu replace public pr�perty 4xmage0 I�e�i:y <br />� _—__ <br />SIGNPtURE � AVV�ICANI <br />/���f'-��'�— <br />noonEss <br />�_,../ �jsa.� %��C s <br />CIt ! IIP <br />_s`—�r— �9> � <br />IELEP1iONE NUM�ER ALiEPNA'E <br />/e_i�.- �-6 <br />��,t <br />