Laserfiche WebLink
eve�en <br />� APP�ICATION FOR RIGHT-OF-WAY USE PERIIAIT <br />Type or print cleady with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERWIIT NO. � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />! <br />HEREBY APPLIES FOR PERMISSION TO ri—SiG161�T� �� �� �M(� I /YG� WCIi �L`YC/C <br />suRFi2cC l 35�L�'�v�r����F C��IPAci � y _ <br />AT THE FOLLOWING LOCATION _ J��3I .� / T — �UF ' "� / <br />DRAWINu (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />�;yr�i �kr�a�c/ afi d�/�J r,�� rH�icl P�IBLrc Rr��T--aF-(�R y <br />Mr�sr,�� 3''�,u�a�� c(ass'�c�`` �sL�/r��7 <br />�' ` � <br />� C �(�� <br />� = �` �� <br />�,,, S <br />� �� � IJ',� �� -�- <br />, ,� -a 1 ,,� <br />/ , ��,� �� <br />� � �;� , <br />U ,. <br />i� � ��� / <br />�� <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. . . � - � <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />AP�FlOVED AS CONSTRUCTED DnrE <br />.� <br />I `�' � �---' <br />,%. <br />, �/ <br />�2� ,/, <br />� <br />DRIVEWAY SECTION <br />�LIP <br />I_30 '1�30 � <br />r <br />The unaersigned owner hereby agrces to hold en0 save harmless <br />lhe Cily ol Everell Irom any antl all claims lor tlamages, cos�s. <br />eRpense:. or causes ol aclion Iha� may arise because ol inslallabon <br />antl maintenance ol t�e improvement or olher ng�t-ol-way use <br />he�Mo apphCd br antl luriher agrees to remove same u0o�� not¢e <br />Imm Ihe Ctly antl lo replare publ¢ pmperty tlamageA Inereby. <br />�-. i <br />/rJ�77 ;! �i; i <br />SIGN iIIRE OF FPPLICANT <br />q 1" <br />� L��Vo�1� � � ��11( �!. ('1�- <br />nooness � <br />1 ) <br />X % L'•(' %C.�� . ' . h X ::: ��i� <br />CItY ZIP <br />u � - ,CU�.S' <br />TELEPHONE NUMBEP ALtEINAiE <br />yl1 / � G� -_ <br />Oa�[ I / <br />CONSbIRUCiION/AS�f3U1LK �EE tg7g <br />