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i I <br /> I !Y!�!M � <br /> � . Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT '' <br /> ; � Type or print clearly wtlh mk <br /> � �� PRESS HARD-YOU ARE MAKING COPIES <br /> I PUBLIC WORKS � <br /> EVERETT,WASHINGTON PERMIT NO. gv�Ya <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED, If ANY: � <br /> HEREBY APPLIES FOR PERMISSION TO <br /> AT THE FOLLOWING LOCATION 1 � �� �� � � � 1 V e� �"` �� ' <br /> DRAWING (WORK TO BE OONE) OR THREE PLANS ATTACHED: <br /> C'ONO�i iUN S <br /> / 1.✓/ i /�i'.c'TiC�J (7r' i�/t O�liu.,�N./��S <.I.TN�N ii,6L <br /> /�UiSlif .C�ipi/i Ur („i/ly ./I�G�Si %j� t�rlt�iU, <br /> �-I �p � S<=i�i�i2.�/i iciJ illl.s: /,jE �niJ.i✓,—.7iNz, <br /> ��.—w,��.�1 OP:u-fw�/yS, <br /> do�.,�,z Ui� FITGINI'�f �f g%vi�17 a, <br /> �• <br /> DRIVEWAI' SECTION <br /> PERMIT IS VALID FOR 60 DAYS � ---� <br /> COPY OF THIS APPLICATION TO BE POSTED �i" LIP �I <br /> ON JOBSITE. � 30" I _L3o"_I <br /> CALL FOR INSPECTION 259-861 1 � <br /> 24 HOURS BEFORE CONSTRUCTION T�e unticrsignetl owner hereby egrees to ho10 ene save harmless <br /> t�c Cily ol Everett Irom any an0 all cleims for Cameges. msis. <br /> eepense5.or taus¢5 0l actiOn Iha�may Brise:ec2use 0�in5lallaUon <br /> an0 mamtenance ol Ihe impmvemenl c other ng�4oi�way use <br /> hereto appbeC for ana tvrl�er agrees lo remove sanie upo�•�otice <br /> Irom �he C�Iy anC lo replaCe pu�hc p�operty �amagea Ne�eby. <br /> DEPARTMENT APPROVALS <br /> SEWER COMMUNICnTiONS <br /> URA�N�GE <br /> 1RFFRC /��^f'I/ _ / � <br /> /'—i ' <br /> J!— <br /> WPTEP I I I � `. , . . PIAIJNING S�GNn1URE Of PCPU Nl / <br /> . : 1 /�>/v �%�..�- /� !�. <br /> siaeet .. ,_ nooaess <br /> / r� ; <br /> �,�-r� ��zG� <br /> 1/ � � " GiV / ZIP <br /> APP O/VE� CON TH GTION. _ . ..........��0 3 7�—`S � v <br /> � I _ �. :1 :.�1� �ir. :�� IELEPRON[4UM9CR ALiERNPTE <br /> G�� ( ;�;� ,,��. � �� �l - <br /> A D AS C STflUCTED Dni[ OAtE <br /> CONSTRUCTION/AS BUILT �Ee 1978 <br /> , ___ <br />