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!Y!f!M <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print cleatly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS �J� <br />EVERETT, WASMINGTON � PERMIT NO.�"� 7S <br />�/ �y! r <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY:� � � ��" `� � - /�/ / `� <br />HEREBY APPLIES FOR PERMISSION TO �/ � Y�' ��'' C� � T� �� �� t' �'`�On I <br />AT THE FOLLOWING LOCATION - <br />T �riD <:E �Y</« T % <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />d���j1 r. J�. " �n ;f�,.,. .� � �l_.'' i ��� ,` .� �� .�_ <br />PERMIT IS VALID POR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-891 1 <br />24 HOURS BEFORE CnNSTRUCTION <br />SEWER <br />on�iNace <br />WRTEH <br />DEPARTMENT APPROVALS <br />COMMUNiCAf10NS <br />innrric <br />, <br />1 .;-, i , C-L- <br />L)\ r�q li . � � �LJX�^'v % �(_� <br />APP pVED FOP C��ST 11CTIDN Dni[ <br />APPROVEO ASCONSTRUCTED OAtF <br />i�s.� �,;en�;.�_corv <br />t� <br />, � . ,� (, ' �/" <br />DRIVEWAY SECTION <br />� � <br />�I" LIP � <br />I" 30 T 'T'30 1 <br />The undersignetl owner hereDy agrees to ho10 anA aeve �armless <br />the Ciiy oi�Everett Imm any enC ell claims lor OnroaBes. costs. <br />ecVenses. or c-uses ol ac�ion tnat may arise �ecause of inslalla0on <br />and maintenance ol I�e improvement or olher ngb4ol-way use <br />hcieto apPbed for antl iw��er agrees m remove same uv�� ����ce <br />Uom Ihe Ctly anC to replace pu�hc pro0erly Camage0 there�y. <br />� ` V �N � ���rl ! L <br />$IGNAtUAL O� /P�'IICANt <br />''y 7/ 7 �i�✓� %"N C.� /< � <br />v' <br />nDDRE55 <br />�% � � <br />�fIC i Ti L(/� J�✓� u_ <br />CITY ZIP <br />..i�'�' �/%�U .l � .;�(� <br />iElEPHOf�E NUMpER ALIERNAtE <br />onrE" �� <br />1978 <br />