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J <br />eVcr�„ APpLICATION FOR RIGHT-OF-WAY USE PERMIT <br />� TYPe or print clserly wit� ink <br />PRESS HARD - YOU ARE MAKPJG COPIES <br />PUBLIC WORKS PERMIT NO..� l-`"f 5 <br />EVERETT,WASHINGTON <br />APPLICANT (UNDERSIGNED) ANO FIRM REPRESENTED, IF ANV: � � , <br />HEREBY APPLIES FOR PERMISSION <br />' ✓ 33 <br />AT THE FOLLOWING LOCATION <br />DP.AWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />��7�/q�Tion� ; <br />�A�s,-iiJL- r,iNG= 49clsi f�!% =.E'in;inc`J <br />TU �i� �CNii✓tr �iSSTi2i: i iGn1 D,< <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATIUN TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 7 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWEIi <br />O�AINAGE <br />WRTER <br />STROET <br />DEPARTMENT APPROVALS <br />COMMUNICPTIONS <br />TR�FfIC <br />PUNNING <br />� / 1 - Z�S'�P/ <br />/�,f- <br />AP�i iTVEO fl CONSTRUCTION � AiE <br />APPROVED AS CONSTRUGTED OA�E <br />/ � <br />• <br />.'Z� CGn1,ioPno <br />t� z� . =♦.'. r ( , � <br />�i�: <br />DRIVEWAY SECTION <br />�'� LIP <br />30'� _-- �-�-30 =j <br />The undersigned owner hereby agrees lo holtl antl snve �ermless <br />Ihe City oi Everell Irom anY and ell claims br Cemages. costs. <br />e.penses. or cduses of actlo� ihat may a�lse because ol mslallabon <br />and m2mtenBnce o! ihe impmvement or oiher nghi-oi-wey use <br />he�elo apPliea lo� ana �urinci agmes lo �emwe same upon nol¢c <br />Irom �he C�ry an� to mpiace publm O�operty dama)e0 �beieby <br />l,�/�����17% /� .;.-� <br />NI�iU��L Of APPULANI <br />,� 3 C7 iC Q�� - <br />)�ESS/j <br />—"` �'4�/ ZIP <br />.�5� 5�// � z �� <br />.EPMONE NUMO[lR/.�-- �J(} A���A�`A�� <br />n ` / �'J / <br />