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everetl <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />`' Typz or print clearly with ink <br />PRESS HAHU - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON / R��j SQhJ�j�J PERMIT N0.�3�i <br />! 'fj�(�� �/ <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: w�" ! �``��� �� �/��J <br />HEREBY APPLIES FOR PERMISSION TO_Up 1��� kST �1��1`�ls ���� N� <br />�� � i �� �.` i � v /i� � i� � <br />. .•� - • /..- <br />i ,, � � � ., . i <br />DRAWING (WO!iK TO BE DONE) ON THREE PLANS ATTACHED: <br />��,e ��o�t�5 ,9���1I�.6��i9T�=�s 9//9,�?d .�j��% <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTC-D <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT <br />sEwen( <br />pRPINAGE <br />IVATER : <br />� <br />; -, <br />� A P OVED �1 C N CTIJN D T[ <br />/ / � � <br />� �� � j � <br />� , .,� <br />'7' �- <br />0 <br />APPFOVE �� � N6 ED � ' � DA*E <br />✓ <br />DRIVEWAY SECTION <br />�— –� <br />I'� LIP � <br />30" �— ------�.30" <br />�he undersigned owner hereby agrees to holC anJ sare harmless <br />Ihe City ol Everetl Imm pny anG a�l claims br Oamages. msts. <br />c.pense�. or causes of acUon thal may an:e Decxuse ol inslallatmn <br />anE maimenance ol ihe improvement or cibe� nqnl-o�-way usr <br />hereto appiied lo� an� I:n1M1er agrees to removr same upon no�2e <br />Irom �hc Cily and to repl`a[c p1'bl¢ pr�rr�yY;� cd IM1ercby. <br />R761 T �' <br />r .—�Y�/ '!_.�/JL� <br />_ ��" ��%i8 3Fzn knr� <br />� � � � aooi�ess � <br />� S,Er�rrG� l�a • �r8/'y/ <br />� � Crtv � Lr <br />� �23•0�3/ <br />rElEv��pHE NUMOCn RUE�NAtc <br />on✓—J " O <br />COi�JSi,u�:Tl•,.;.�:;:.^I'Ir��- ���.t <br />197$ <br />