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<br />APPLICRTIO�1 FOR RIGHT-OF-WAY USE PERMI
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<br />PERMIT NO.
<br />6b
<br />PUBLIC WORK��
<br />EVLRETT,WAShINGTON _ __
<br />APPLICANI� (UNDE�SIGNED) AND FIRM REPRESENTED, IF ANY:
<br />HEREBY APPLIES FOR PERMISSION TO
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<br />AT THE FOLLOW�!+G LOCATION ��/ �-' �fiv
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<br />PEiiMIT IS VALID FOR 60 DAYS -
<br />COPY OF THIS APPLICATION TO BE POSTED
<br />ON JOBSITE.
<br />CAL24 HOURS BE ORE CONS RUCTION ''
<br />DEPARTMENT APPROVALS
<br />. — COMMUNiGATIONS
<br />SEK'ER
<br />��1
<br />TRAiFIG
<br />pqAINAGE
<br />—�'� .
<br />PLANNING
<br />WATER
<br />SiPEE ^ -_
<br />�-.�G7 1 vi i
<br />�oci
<br />DATE
<br />qP ROVEDFORCO S:R TION �/ r A
<br />, , �.,
<br />UATE
<br />D AS C N RUC EO
<br />CONSTRUCl10\iAS BUILT
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<br />DRIVFWAY SECTION
<br />I ���I'� LIP _._
<br />3�—
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<br />30'�
<br />The undersigne0 owner hereby agrees to hold and save harmlass
<br />the C�ty oi Eve�ett irom any and all claims for damages. costs.
<br />expenses. or caU5e5 ot d«�On �hat may ariso beCauSe OI in5tallalion
<br />� antl ma�nlenance of Ihe improvement or o�her righl-ol-way use
<br />herelo appGed br an0 iOf1lrace�publ c P«PQOY da naged t�her�eby.
<br />iro�n Ihe C�ty ane �o �ep
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<br />TEIEPHONENUMOER '�
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