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everetl <br />Q APPLICATlON FOR RIGHT-OF-WAY USE PERMIT <br />VType or prin� clearly with ink <br />P78LIC WORKS ' '� � � � . . .� . �,� .�... . . <br />EJERETT, WASHINGTON PEFMII NO. <br />S / `/ <br />APPLICANT �UNDERSIGNED) AND FIRM REPRESENTED, If AMY: `—'�� ���'" �" � � �V ��jf-'j � �� <br />HEREBY APPLIES FOP PERMISSION TO l� 5'L-- �� �� � <br />� _�, ,r� .,vT��� �,�// � �.,,,,� , <br />AT THE FOLLOWING LOCATION /�/ � c-: . Fj �'� : S/. �� L.._' <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />P��fMViIY IS VALID FCpF� 60 DAIVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />�C;.t�,� �_ �cL?et u'!tv,r"..�'E''€�':� u y�";E�" ,":<.,- _ - ..`::a 9 1 <br />2q NC�JR� �C';'C`I*.� � Ci,=: '� ;;.;,;,: <br />DRIVEWQY SECTION <br />., / <br />+I" LIP <br />E�3Q�-- 30�� <br />� The undersie�ne0 owncr �ere7y aqrees to holC and save harmless <br />Ihe City of [verell irom any antl all claims lor tlamages. costs. <br />j expenses. or causes ot aclion ihai may anse because o/ mstalldbon <br />� ��� �� � �� ` �` "�� -� -.. _. _� dn0 mainlennnCC ol IOe unprovement Or olhCr ngh�-Ol-way u5C <br />. . _ .. . . ... . , _ . . ...... <br />heret0 npphe� �o� antl Wr�he� agrpes Io removC Same upon nol¢c <br />DEPARTMENT APPROVALS ��o���. me en�� „�a io �epwc� �„ni�c o�oo�nv ���+�,�ea m��eny <br />s�.:rn ------ <br />COMI.tUNICntiONS <br />O�AINAG[ <br />WATER <br />STHEET <br />PLANNING <br />APPfiOV[D FOR CONSI'RUCTION pqiE <br />APFROVEDASC<iNSTfiUC;lEI) . .. '---- --�----.-.... ..----.. <br />% <br />�!/ b7.r �� :...�- <br />SIGNAi�1RE O� AVPL ��i � � - - � � � � ' <br />�L�'L� , GGG'.c'..�%L'��/`� .G%�y <br />ApfJRE55 <br />Gv t:,�>ft .—r y5 20:3 <br />CIiY ��� <br />.J7 _� _ �/(.c� � <br />�R[PnONE NUR�l3ER a�tERNhlt: <br />7 /G> — � `i <br />ornE � <br />7978 <br />