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F] <br />_.�. J. <br />� • . � . <br />. !Y!►!It <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�; Type or pnni clearly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS �J � � <br />EVERETT, WASHINGTON ' PERMIT NO. r � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANV <br />HEREBY APPLIES FOR PERMISSION TO <br />' � , <br />AT THE FOLLOWING LOCATION <br />B�JD <br />r <br />DRAWING (WORK TO BE DONE) OR THREE PLANS A�1'ACH�D: <br />I <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TQ BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-681 1 <br />24 HOURS BEFORE CONSTRUCTION � <br />SEWER <br />ORPINAGF <br />WATEN <br />DEPARTMENT APPROVALS <br />COMMUNILAI IONS <br />LN <br />PLANNING <br />SiRE[T .'/ / <br />// ' . � / <br />�_-� � ��/),f�, �.:�.,� `� -'� y_�;:/� <br />AFPROVED F R CONSTRUCTION OniE <br />'�� APPROV@D AS CONSTRUCTED OAiE <br />(iEFERENCG COPY <br />� <br />x <br />DRIVEWAY SECTION <br />I�� LIP <br />i'3°,i' � _'�'3---� <br />�e un0ersigneG owner hereby aprees lo hold en0 seve harmlass <br />�he Cny of Everetl Irom any anG all claims lor Camages, costs, <br />expenses. or causes of action t�at may anse because of mstallalio� <br />and mein�enance 01 Ihe impmvement or o�her rigM�oLway usc <br />herelo appLed lor ane luriher agrees to remwe same upon nolice <br />Iwm �he Ci�y and lo rr0lace pu01¢ property Damaged ihe�e0y. <br />- ' "__ i i � . ". �_ 1 M cl� <br />Si ATURE Uf APVLiCAM <br />-;,�,��� . �< ��ti, ���c� _ <br />nooaess ( \ ` <br />�) r C <br />C �; C I �.�� �. '�. � �\ � c� � � 1... '- , <br />cnr zir <br />_.. ��'�:� �l�l '.`iL`t'v <br />IELEPMON[ NUMOER , ILiERNNIE <br />I <br />_ l -7 r� (j _ <br />OniE � / <br />