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, <br />everetl <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />v Type or print cleaAy with mk <br />PflESS HARD - YOU ARE IviAKING COPIES <br />PUBLI^ WORKS . <br />EVERETT, WASHINGTON PERMIT NO. "> ) - � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISS:ON <br />AT THE FOLLOWING LOCATION 7 1-_3 f�I " 3 � S �� S` t� S. W, <br />DRAWING (WORK TO BE DONE) OR THREE PLANS kTTACHEd: <br />�. C�XJSTi/JI—' .�//J?/✓i-///� �C �G'4i�1 ✓. /J.U/T,ft� /'%?�' //Ni7/�4JNl•�:"�� ' /%Ny <br />Di,��irll-� /Jc.v_ %D StLiic_ /-'Udiiu�— l�vnisn?e,�TiU�,/ /✓2c f�� .(�PrrJulr> <br />Q�Z �l�•.UriJ�iJ �Ivd .�,i%�/(�f / 7C ii/c'- %�i.dLiE /�C�T��S //u�,>,ii :G,I �s <br />g/-l: / � r"�%� i i0r✓ <br />.� ��'ris,-iNt- Dn'ir,�„u,��s .`�i-�lc.sd /1�� UriCi2ad -C�C N-i!✓ /1G,lic`5. 1_r' <br />N�L✓ iJ/i.r��iCJ��jS /ii-Jbr_.� 7J� i�c //LSi/-JlL�CJ %//G' /'X/S.-iiV!' (�UA'i� � <br />�l.����,�J /IJUS� %�G Td��/CLy n'•a�//Cd��U X .�i'f�(iil7"/J /%% N/-./t.' /%iliU.�%:./� <br />LL[fdi /G'..✓S ,/C r=X/Si �N/- /J.1iUi%�✓�// /�. Fi-li':[:Y✓S. .C�Nc'!Ki/u(- O�� <%/- <br />��U.�'� /S ✓voT i 1L t <N«�J. <br />J�. /-JLC (�Ci�PiT4'T.� .C�:.//suiJ[ S /JiCiS - /J.� S°i-/�U -rLiT l / -. /ir,. �✓ Ou% <br />j . _' rA.!/.JjiLa/ JO�ivi <br />G ni.r,/d., >� <br />/%/ST.�I.vf< �c'Tiv.: i'i�/ /Jn'iG-�'/✓�IyS Gr✓ T-�� .Sr�iiic %,is=FG C�= j �il.,i� "•Ji/ <br />Ci. T�E cXis.-i/i.k'" /Ji?iL_.-l..�/ �S�+V�✓i✓ <br />/»osT fJE rl ��i.vuiii�.ii Gr �c rya'%, <br />(N �f/eE /2/7il/ %C A�fi/i/-/iA1� /)J[��T /3.i ,f6iiieu,:U /i TNiS A.t'i�r:iliN- <br />/�i-liv.✓OT f3c' ///E i, <br />PERMIT IS VALID �OR 60 DAVS <br />COPY OF THIS APPL�CATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259�-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DN4INAGE <br />WATER <br />DEPARTMENT APPROVALS <br />COMMUNICAilONS <br />TRAfFlC <br />P�ANIIING <br />��. /fc,_7— ��.�3/t'o <br />APPROVE� F R CONSTpUCTION 0 r�E — <br />/ <br />A P�ON UCTED �� <br />�ONSTRUCTIOIJ/AS BUILT <br />DRIVEWAY SECTION <br />I�� LIP <br />3� _I_30"� <br />T <br />T�e untlersigneC awner �ereDy egrees ta ho10 and save �ermless <br />t�e Ci1y ol Evereil Imm any anE ell claims lor Oameges, cos�s. <br />expenses. or wuses ol aclion Ihal may arise because of in5lallation <br />anE maintenance ol Ihe im0�ovement or ot�^r nghPol-way use <br />�ereio aOG��eE for antl further agrees to remove same u0on not¢e <br />Irom Ihe ]iiy antl lo replace publ¢ properly Camage� �nereCy. <br />�_"' ii��� —���"� <br />SIGNAiURE OF APP�ICANi <br />G�1��i ��t ���y �t� <br />AODPE55 ' <br />�v���T 9f'z �3 <br />LITY IIP <br />3S 3 - 9/UU <br />TELEPNONE NUMBEB q�iERNAiE <br />J / L �U <br />04 E <br />1 <br />