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. everen <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly •.vith mk <br />PRESS HARD - YOU APE MAKING COPIES <br />.r 1 .�\ <br />PUBLIC WORKS PERMIT NO. ' �' <br />EVERETT. WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FJR PERMISSION <br />AT THE FOLLOWING <br />`' ' BI"s0 Xo��c-r <br />,r��N _ <br />DRAWING (WORK TO BE DONE) OR THREE PLANS A�fACHf4D: <br />P�RMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION y <br />DEPARTMENT APPROVALS <br />COMMUNIULiONS <br />OR�INAGE TRAf f IC <br />P�A'. V WG <br />sraEEi .;� _ <br />�� , . �� ' � <br />.' � ±l . � ' , r� - ". <br />� ry`: .'r�j�� � ' /, <br />APPFOVEDf R GONS RUCTION CAtE <br />APPfiOVCD FS CONSTRUCTF� <br />' k <br />t , <br />F <br />ORIVEWAV SECTION <br />I" LIP _� <br />�3�� �_30"_� <br />l�e untlersigneE owner hQfCby Pg�CCS \0 h01d A�d 38VP, hB�TIC45 <br />the Cily ol Evereil Imm any an0 all cleims lor Eemages, costs. <br />e+penses. or causes ol nctio� tnat may anse because ol mslallalion <br />an0 maimenance o� 1ne improvemenl or olher ngM1FOPwny use <br />heiMo apOLea foi and Imlhe� agrees In remove same upon nolice <br />irom Ihe Ciry and io ieplace pubbc O�opnrly tlnnagea ihere0y. <br />c.L+ .� ^%I �:...{ u M c A <br />51 AiUALOfAPVIICRNi T�� <br />�\ <br />_. _%l�i i �� v' � �-�. ''�•\u� <br />nooness � v � <br />-- �,: � ' � . 1��, c.�.�� �L. "� <br />cn v z'v <br />-.. � _ � `� 1 _ � �i � '� _ l. � L � � � <br />1[LfPHONE NUMp[P PLtERNRTE <br />-�"���; (> - <br />C4TE <br />