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everen <br />Q APPLICATION FOR RIGHT-OF-WAY USE PE�iMIT <br />vType or print c�eaNy wilh mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS � <br />EVERETT, WASHINGTON PERMIT NO.__� <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTEU, IF ANY: <br />HEREBY APPLIES FOR PEFiMISSION TO <br />AT THE FOLLOWING LOCATION <br />8 /3 0 <br />DRAWING (WQRK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALIt"J FQR 60 DAYS <br />COPY OF THIS AP�LICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTIOfd 259-837 1 <br />24 HOURS BEFORE CONSTRUCTION <br />5[�v[n <br />OR�INAGE <br />DEPARTMENT APPROVALS <br />CJMMUNiCAlipNS <br />TRAfFlL <br />RpNNiNG <br />sineer ; <br />/% � <br />� �4� <br />� ,,� -� : <br />� C�'�r' <br />APPROVE� F R CONS UCTION DATE <br />APPROVFOASCONSTRUCiED <br />-• i � - —.' ' . —_. <br />DRIVEWAY SECTION <br />� -� <br />�— +I" LIP <br />30'� �r 30 "� <br />The untlersigneE owner hereby agrees to �old antl snve hnrmless <br />Ine City oi Evere11 Imm eny antl ali claims lor Eamages, wsls. <br />eRpenses. or wuses ol aclion ihal may anse �ecause ol mstallalion <br />antl main�enance ol lne imF���emenl pr othcr riqfiFol-way usc <br />��c�clo api�lirtl Ipr Tr� hnRier agmes lo rmnure sa�ne upon noli�r <br />Irom IM1e C�IY ���4 to rpplacr pubhc t�mpeitY h�����grcl :'imepy <br />- �� ' ! I /. J �� - __... <br />9GNAIUHE OF AVf+�IGpryl 1 - <br />��� .Z {:.' �,�rY1J � V�,,r�� <br />nooaEss - ` --- <br />r� � �� :: <br />•�,*: t <.-- ��,.<< � � 7�_ _ <br />Cliv LP <br />�� . (. (' <br />. �. _i-�'IG'`� t�-'� 7�� ' 1 %; I�i <br />1ElEPNON[ NUMBER ALifANRiE � <br />� � ,. � , ,. <br />pPIE <br />