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everetl <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />vType or print clearly with ink <br />PRESS HARD - VOU ARE MAKING COPIES <br />PUBLIC WORKS T9 �5D <br />EVEREtt, WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED} AND FIRM RE?RESENTED, IF ANY: �� �L ������L' ' ! �� ��;' �/�, � ,v� <br />HEREBY APPLIES FOR PERMISSION TO "�`"� �" ~ `,� ''�'��/�'-' � ° ��' � � � � '� - <br />AT THE FOLLOWING LOCATION 3 � 09 ✓ � � � � '�v ' -- <br />DRAMlING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY UF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR IPiSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />sEwEn <br />ppAINAGE <br />DEPARTM[NT APPROVALS <br />con+r.+uwcnrious <br />DRIVEWA'i SECTION <br />�_ � I" LIP <br />�30-i----- -L30 -I <br />The untlersigned ownu hereby agrees to holtl antl save harmless <br />Ihe Cily ol Everelt Irom any and all claims /or tlamages, cosis. <br />exF�nses. or uwse; oi action Ihat may anse Oecnuse ol ins�allabon <br />une: rnanlenanCe nl Ihe improvemcn� or other nghi-O�-w�y use <br />licre•lo aPGLeo loi ,�ntl Iuri�mr agrecs lo remove Same u0on nohce <br />troni N�, pnY nn,f to repiaca Pubi�c proVenY �amn9e[f Ine�oGY. <br />iRAFHC � �� <br />� �>' �' .�� <br />_ d <br />VL4NNING tiIGNA1URE Of APFLiCqA� �/w�( <br />.>!/ 6�./ <br />�il- � %' - /-' J - i_'.� _,� <br />�. ;, <br />, � <br />� <%�� ;� `�-� I �� - �-3- � � <br />TPPROVED FO C N`�RUCTION 0/+iE <br />�� , � --�?C) <br />��. ��.��_ _ � -� _ <br />APPROVED AS CONSTRUCTEO DAiE <br />coN�Tr-,ucnor;�:�,S L3UILT <br />.�; . � <br />_,, �-�_.._ , �.�;:�. ; �'ro <br />��. - Z�,. <br />6 y� � o- I��" . <br />1[LEPHON[ NUMBER ALTEFNAtE <br />�� /%�/�y <br />❑AiE / <br />