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everetl <br />e <br />APPLICATION FOn^ .�',iG�IT-OF-WAY USE PERMIT <br />T�pe or print Cleetly with mk <br />PRESS 4AR� - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WqSHINGTON <br />APPLICANT (UNDERSIGNEO) AND FIRM REPRESENTED, IF ANY: <br />LAr�� SoNssa.i <br />PERMII' NO. J '� _ <br />/�1.�0 �'...YL'i <br />',I HEREBY APPLIES FOR PERMISSION 7p�� -l�ra�� �,r�.sT � ��i,,� ��r- rar �e�N � <br />• • .. . . /i � � ' � i � � <br />— � j �I / <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />� � � � �Ii. I= /I � ,l • ��+ ► <br />�I . � <br />�� <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLI�ATION TO BE POSTED <br />ON JOBSITE. <br />CALL F'AR INSPECTION 259-681 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT AP <br />SEWEN �� <br />ORAI4PGE <br />WRTER <br />� <br />DRIVFWAY SECTION <br />� I" LIP --_�l <br />� 30� � .� 30„ <br />The undeBlgneC owner hereby agrees lo hala ana save harmless <br />the Cily ol Everet� Irom any and �II c�pims lor demages. coSls. <br />eepensM. or causes ol aclion Iha� may anse becnuse ol installalion <br />ana mainlenante O/ Ihe �mpiovpmCnl pi ol�ei ngM1bol�way u5e <br />hercio aOPhed lor and furihei agrces to remove same opon notme <br />i�om me Cny a�a io �ePiace n�ei�c o� �,iyyi�yqea tnere�y. <br />�� T � yflR <br />C �/ 1 �%�/�/� <br />-�.v iGNATURE Of aVPUCnN* <br />�//8 3�G',tr� <br />� - ' � nDD�E55 <br />'` <br />A P VED F fi C N� CTION Q ��� 4 1� <br />� ,E <br />i , <br />� � '�i � ti,v <br />APPROVE � NS ED � � ( OnTE <br />CONSTHUCTION/AS BUILT <br />S�faTrG� � l�ra . �jg/�/ <br />Z,,. <br />tc23 • 033/ <br />1ElEPHONE NUM�ER A�IERNRIE <br />�� Mr.�,7 So <br />OA*E — — <br />rc <br />