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. . <br /> 1 <br /> -� �._ .. . <br /> , . <br /> « - <br /> APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> � Type or p• nt cleerly.wilh ink <br /> PRESS HARD - YOU ARE MAKING COPIES / <br /> PUBLIC WORKS �O �iQ <br /> EVERETT,WASHINGTON PERMIT NO. — <br /> APPLICANT (UNDERSIGNED)AND FIRM REPRESENTED, IF ANY:��a�� t7 G � �fA N�Sd I✓ <br /> HEREBY APPLIES FOR PERMISSION TO G ��bTI�, 2= FT ASPH'�AC+T' �/G�J <br /> ' AT THE FOLLOWING LOCATION_ ��a`� ��� R� �'1 �P � W i <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br /> � <br /> ORIVEWAY SECTION <br /> PERMIT IS VALID FOR 60 DAM� � � <br /> COPY OF THIS APPLICATION TO BE POSTED �- + i�� LIP <br /> ON JOBSITE. I <br /> CALL FOR INSPECTION 259-881 1 1=30't• �_30" � <br /> 24 HOURS BEFORE �ON$TRUCTION Tne undersigned cwner hereby agrees !o hold antl save harmless <br /> Ine City ol Everelt from eny and all claims lor tlamagbs. cosis, <br /> evpenses.or causes ot aclbn Ihat may anse Uecause ol inslallation , <br /> an0 maintenance ol Ihe improvement.or other righi-ol-way use <br /> � ' ' hereto apP��ed tor antl lunhar agrees to remove same u0on nolice <br /> Irom �hr. C�ly and to re0laca p�hlic 0'o�erty tlamagetl IhereOy. <br /> DEPARTMENT APPROVALS <br /> SEWER ' COMMUNICATIONS <br /> URAI!lAGE TRAFFIC <br /> � `7(I �7?.�f.���<_C �� _ /C-H.y.--��L� <br /> WATEH PLANNING ` SiGNATUR/E/OF APPLICA ///�/ ,, l <br /> �z-'7 �' � Y 6 ��c . �'/' Y(')• <br /> STREE n ' �AO�R 55 , � I <br /> V ;': . <br /> �,� ��1��-.. ��. ���1- ���-7� <br /> . <br /> PROVEC R CON THUC710N �RTE - � C��� , �p /I{'�� Dr <br /> 77 <br /> TELEPHONENUMBER ALTEPN4iE <br /> ' - - ��._3-� ,� y.� - �S-�- ----- <br />