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� <br />� * _ " 5°�j�;o�,� <br />everen <br />� APPLICA'T'ION FOR RIGHT-OF-WAY USE PERMIT <br />Type or prin� clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERMIT NO. � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY:��L� '4C� GO�vS T. ���^'i�PKC Yl NAL/1 A�H ) <br />HEREBV APPUES FOR PEHMISSION TO uS E �i L� F 1' FOR AC c lSl P� P�RK/ ^�� <br />AT THE FOLLOW�NG LOCATION Z 5�' 4 w'°�^ivr S�' . �(/a� �, �A�a 7� O� - <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-861 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />p�41NAGE <br />\VRT[R <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNIGt10N5 <br />P�ANNWG <br />APPROVEDF R CONSTR CTION ^'E <br />_ , i �„', . <br />DRIVEWAY SECTION <br />� - � <br />+I'� LIP <br />� 30�� �30,� <br />The unUerSigneE owner hereby agrees Io OOIC anE seve hermless <br />Ihe Cily o7 Everett Irom any nntl all claims lor Oemages, cosis. <br />e.penses. ur causes ol action ihat mny anse becau3e ol mstalla��on <br />anE ma�nlenance ol ine �mpwveme�t o� other righl-obway use <br />M1e�elo a0P6eE lor an0 Imlher agrees to �emwe same upon not¢e <br />Imm I�e Gty ana to replacr pubim pruOPrry drmaged inere�y. <br />� �� <br />SIGNAtURE Of I�PPLILFNi <br />Li3t If�C�i�4�✓a <br />nooaess <br />LEyz�f G�.os�I i82o1 <br />Gtr 11P <br />ZS2- � VSo <br />�I I F�IION( NUI.1(1[H ALLGRN4IE <br />