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!Vlft11 <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print cicarly wilh inA <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC HORRS �' "� �''' <br />EVERETT, WASHINGTON PERMIT NO.�2SG„C.�.d�- <br />/ / <br />APPLICANT (UNDERSIG�ED) AND FIRM REPRESENTED, IF ANY: �L- ��L6 <br />HEREBY APPLIES FOR PERMISSIUN TO �u i<�` C� �.C� 7�U �Aj� � f�,�ovf�2 6 E�/ <br />AT THE FOLLOWING LOCATION _LS3 �- � �� ��LvsL.r.�T <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />� <br />v <br />\ <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-891 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENTAPPROVALS <br />SEWEH �pMMUNICA*IONS <br />DN�'iN�GE <br />Fi 4NN W G <br />DRIVEWAY SECTION <br />I � <br />I" LIP <br />�0" � 30" <br />The un0ersignetl owner hereby agrees Po holE antl seve �armless <br />Ihe Ciry ol Everett Irom any end all claims br tlameges, cosls, <br />espenses, or causes ol aclion I�at may anse becnuse ol mstallalion <br />an0 mainlenance JI Ih2 improvemeni or oiher n5h�-Oi�way use <br />here�o appiiea lor and IurlM1er agrees Io remove samv upon nol¢e <br />liom I�e Gly anE to replace pobhc properiy tlamagetl t�erxby. <br />! <br />i <br />SIGNAiIIRE F APPLIC�1Ni <br />�r�t/2fi-��� <br />aoo�ess <br />-.��-� �i�.P i6�s' e <br />c� n� <br />..S`__`P_ �1�� �— <br />TELEPHONE NUMB[R AUERNAIE <br />Ci /O_./*/� �'G <br />CO(aSTRUCTION/AS DUILT <br />