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• �.1 <br />everetl <br />Q APPLICATION FOR RIGMT-OF-WAY USE PERMIT <br />vType or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT,WASHINGTON PERMIT NO. � = �'��_ <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: i. 1 _%•. ., ,, <br />HEREBY APPLIES FOR PERMISSION TO �-�'•< <��T� �L � � - /��- ti���-���\C- ��U <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />1 ��� � � �� � r <br />�. � %f <br />1J% ':!.) ;' <br />:� l ��� 1 �� �: <br />1 <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APQ�ICATION TO BE POSTE'.p <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />5E\vEn <br />ORAtNAGE <br />DEPARTMENT APPFiOVALS <br />CCM1�6WNICnilONS <br />PLANNING <br />�APPROVED FO(i CONSTRUCTION On`E <br />APPROVED AS CONSTRUCTED DnTE <br />_ � .' <br />_ i�fir��" % ��� '_ �'-� �LL. <br />i _, . . , <br />�,.I"� ,�,',/� �% ,.;�C f C"���.� <br />� � <br />I � � G,O ,� G� � �r.Y.� �!1'th��l._p ,,r <br />DRIVEWAY SECTION <br />�.-- __-_� <br />j I" LIP --�1 <br />L30" f, _I_30" <br />i - i �-r- <br />The untlersigned owner hereby agrees to holtl antl save �armless <br />Ihe Ciry ol Everett Irom any antl all elaims lor damages. cosis. <br />expenses. or causes of action Ihal may anse bewuse ol installa��on <br />dntl maintenance ol �h� improvement or ulner rign40f�way �isc <br />nereto apV�ietl inr antl lurther ayrees lo remove same upon not¢c <br />Irom Ihe Ciiy and to replace pubiic property tlam�y:tl �hereby. <br />i^, <br />� �V <br />SIGNBTURE OF APPLiCANT <br />: " � � '! �, c � � <br />AOOAE55 ' <br />� ...�' ' �.J -: IJ <br />C�TV 21V <br />'�i!� ' '(•; '/ ' -,v`' ../E � .... <br />TE�EVnONE NUA�BER q���qry�}� <br />� <br />. .... irt. '—___—. . _ — <br />la'/$ <br />