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everetl <br />� APPLICATION FQR RIGHT-QF-�^/AY USE PERMIT <br />Type or print clearty with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />� �EVERETT, WA$HINCaTON� <br />- ----_----_ — -- --------- ------PEF11V1iTNO: <br />�Cn � � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: �� <br />HEREBY APPLIES FOR PERMlSSION <br />� � G �� �N I� I,�L ( <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />� � <br />/�cc �.�t,� � 'fG�.�..��5 <br />�;��� c, �' � ,�� <br />� �: _ <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATIQN TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-961 1 <br />24 HOURS BEFORE CONSTRUCi16N <br />SEWEP <br />DRAINAGE <br />WATER <br />STFEET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />P�ANNiNG <br />% <br />� _:'�� �/ �_ <br />J�v <br />APPROVEDPO CONSTRUCj�ON / _% . o E <br />/� <br />-_,�%��!/'� - <br />%'.,V�ROV[D AS CONSTRUCTE �� OnTE <br />S. u: <br />�' � � ° 9 <br />d IW c� .c ,�/_... <br />DRIVEWAY SECTION <br />� -� <br />�—�I" LIP <br />� 30'�, � . � -.��I <br />� <br />T�e undenigneC owner hereEy agrees lo hold and save �ermless <br />�he City al Everett Irom any entl all cleims lar damages. costs. <br />ezpenses. or ceuses oi action that may arise because ol installalion <br />an0 meintenanCe ol Ihe Improvement or oiher ng�bol-way use <br />nere�o aopiie0 lor antl �unner agrees to remove same upon nobce <br />Irom Ihc Cny ana to re0lace pubbt proDerty Oamagetl �hereDy. <br />/��� � <br />51 nTURE 0� /+PPUC/NT �. �i <br />?z os � ���,, �1�� <br />ADDRES <br />/� < .< /� <br />v�5=�' :i8"L° <br />tELEPMONt NUM9EF AL�ERNAiE <br />�/.'� e � - <br />OATE <br />CONSTRUCTION!�`.SBUILT FEE <br />� ',,' _ ,{, <br />_ <br />�� .aa _ _ <br />