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APPLICAT@ON FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with mk <br />PRESS HARD - YOU �ARE MAKING COPIES <br />PERMIT NO.� <br />PUBLIC VdORKS <br />E�'E9ETT. WASH!NGTQN <br />APPLICANT (UNDEHSIGNED) AND FIRM REPRLSENTED, IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO�s.'� FX/Si/IU� Cor1KRETF �P��E��Y <br />Ai THE FOLLOWING LOCAT!ON_ � �5�� �7 \ l. �� /�O� �� <br />� <br />DRAWING (WORK i'O BE DONE) Ofi THREE PLANS ATTACHED: , <br />� � /" / <br />�� � i III / ���,, �/ <br />V �� �.j'j�Yl. ;����` � �` / /�"'-�t�iv~LG/`��� <br />���;�{ �-�^�.v'� �d �, J <br />�� �, --�_ . �� ;� �-�,� . <br />, i -F-_ <br />��' �-�;�L.�. l, �� ��� Ctitl '' Y : r, <br />IJO G`-' i� C ; " <br />PERMIT IS VALID FOR 60 DAYS <br />CJPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-861 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DPAINAGE <br />WATER <br />DEPARTMENT APPROVALS <br />LOMMUNICA nONS <br />TPNFFIC <br />P�ANNING <br />ti � -�- � � <br />DATE <br />� /O �/ -d� <br />DATE <br />CONSTRUGTION/AS BUILT <br />,. � C,, .;;�.,.,� p l'''�"�:�t'�•'`.-� <br />(J <br />DRIVEWAY SECTION <br />I'� LIP <br />r+-30" � _I_30"_I <br />The unde�signed owner hereby egrees ta �oltl antl seve harmless <br />�he Ci1y uf Everett Irom eny anA ell cleims lor damages. costs, <br />exponses. or causes ol action that m2y anse because ol installelion <br />antl main�enance ol t�e impr�vement or other righl-ol-way use <br />here�o appbeA lor and Iuriher agrees �o �emove 5ame u0on nOhce <br />ir�m �he Cily an0 lo re0late puDbc p�oPerly damagetl Ihereby. <br />/ � /� S ' <br />� v v . <br />uNATURE OF P PLiCANT <br />� �F�P�Q`Gl� ��i�✓ _ - <br />Ap� <br />„� 3 <br />�,���T �?° <br />3�s-9/�''� ��2 f�'783 -- <br />TE�LEJVHCNE NUM6ER ALIENNAi <br />f�D YG/J'� <br />D�TE <br />a <br />