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!V!f!M <br />e <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print cleady with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO. �� <br />°UBLIC WORKS <br />EVEHETT, WASHI�GTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION Z- G D Z R�$ W4 �n ~"r St <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 />ON JOBSITE. <br />CALL FOR INSPECTION 259-887 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DR�INAGE <br />WpTER <br />STPEET <br />DEPARTMENT APPROVALS <br />COMMUNIGPTIONS <br />tR�F�iC <br />PUNNILu <br />�PPROVEDFOR CONSTRUCTION �A�E <br />�,r- <br />DRIVEWAY SECTION <br />� � <br />I" LIP <br />30'� .� �� � <br />The unEenlqne0 owner �ereby eBreas to �olA anE seve �armless <br />I�e City oi Evarelt Irom eny end all cleims lor Cemages, coste. <br />eapenses. r,r causes ol aclion t�al mey erise �ewuse ol inslalletian <br />ana maintenence OI Ih¢ imprOvement or oth¢r riq�l-af�way use <br />�erelo apphed lor antl lur�her agrees lo remov2 same v0on nobce <br />Irom i�e Gty ana to replace pubhc pro0erty aamage0 i�ereby <br />SiGNai�Uc . —_ <br />�s� 3 L/Nc'r c�L h �� <br />ADDRE55 <br />s'� �ha yrn� sJ, _ r,,,,, . 9�.�90 <br />CiIY Z��' <br />.i"'� � - � 3 3 � <br />tEL[PMONE NUM�E� AUEANPiE <br />//-.3��- _�-- - <br />