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i 4 <br />i . ' ', <br />everetl <br />Q APPLICATION FaR RIGHT-OF-WAY USE PER3V:�T <br />� Type or prin� clendy with mk <br />�� PPESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WOHKS � , - <br />EVERETT. WASHINGTON � PFRMIT NO. �� � <br />APPLICANT (UNDERSIGNED) AND FIRM RFPRESENTED. IF <br />HEREBV APPIIES FOH PERMISSION TO <br />AT THE FOLLOWING LOCATION <br />� <br />(` k n � , r'r 1i'�. <br />DRAWING (WORK TO BE DONE) OR TNREE PLANS ATTACHED: �� ��-�o <br />�� e � o ��� o:. .� � <!-4,�-e d Y ��1 e`^i J <br />t,., , d�-(i� �.; � � �\o � ,'t � l7 t�v <br />ave�. <br />� �_ <br />v l� l `�l �"D <br />PERMIT IS VALID FOR 60 DAV'S <br />COPY OF THIS �PPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-681 1 <br />24 HOURS BEFORE CONSTRUC':ION <br />SEWEF <br />ORRIN4GE <br />WAiER <br />STREEi <br />DEPARTMENT APPROVALS <br />COMMUNICPTIONS <br />TRAFfIC <br />PLANNING <br />AFPROVEDFOR JONSTRUCTICN onTE <br />��pr.iiveFo�rnNsrni�C�m — n^.r <br />ORIVEWAY SECTION <br />I" LIP � <br />j�30 � � ' 30 "I <br />i�e untlersigneE ownor hereby agrees to holtl arA sam harmless <br />Ihe Ci1y ol Everelt Irom any enE all elaims lor aameges. cosls. <br />e.penses. or causes of acbon ihat may anse b:tause of inslalletion <br />an� maintenxnce ol ine improvement or other ngnbol-way use <br />hcre�o eppbea lor ana Iwiner agrees to remov� :ame upon noticc <br />Iwm Ihe City aotl lo wplace publ¢ propeny tlnmagea inere�y. <br />-� 1 � t: <br />/. � �,.: - `� - - <br />SIGNAipRE OF AFPUG�N1 <br />� J' �L � • •.1- T �.'e\� l /=J <br />AOOR[55 <br />r <br />171i.�1'ICT�u l.,n /�„/.�� <br />C�iv LIP <br />JJ r/'GS l <•�/�- JIUD �J JU <br />IELEPnONE NUA�OER AIiEBNPIE <br />l�4if <br />`-, L�.`–___' _ __.--_—_-- <br />�� <br />