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everett <br />Q APPLICATION FOR RIGFIT-OF-WAY USE PERMIT <br />� Type or print clearly wi:h mk <br />`� PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS � i� <br />EVERETT. WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTEO, IF ANY:._ '�_—i:--! - � F' �"` <br />HEREBY APPLIES FOR PERMISSION TO l �� Tv �C � � �� —k ���`� II/ <br />AT THE FOLLOWING LOCATION <br />./i� -. . __ �F - <br />i, . � <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />� <br />�--�J.,' -�, � �. <br />�/ U� t�;sv� <br />;:• <br />��, � � �ti. ., ; e <br />r �� <br />� � ..�� �_Q_ . <br />, <br />, <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 7 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />pRAINNGE <br />WATEfi <br />STREET <br />DEPARTMENT APPROVALS <br />cor.+niunicnTioNs <br />PLANN�NG <br />APPROVFDPORCONSTflUCTION DnTE <br />qPPPOVED AS CONSTAUCTED DAiE <br />'r;'I I �.'(;Tli�'I�.�,i�;" . <br />'�,�, .._ ._ ... .�.. <br />^� f.l✓��i�... .•�_� � /L6"��.I C/� ��Yt-�.. <br />� ' <br />I ��) , , titi�� <br />d- �i� ,� , W ��� 1���-�- i C1" <br />�%„v � ��.� �(�,� �r <br />�J � �o ,� l ��,;� � a� � <br />DRIVEWAY SECTION <br />� �I" LIP <br />�30�� �— �3�" <br />T�e untlersignetl ewner hereby agrees to holtl antl save harmless <br />Ihe City ol Everetl Irom any and all claims lor damages. cosls. <br />expenses, or causes ol acbon ihal may anse because ol insiallabon <br />antl main�enance of ;ne improveme��l ar othe� nqh4ol-way usc <br />here�o .OPliea lor antl lurlher aqrees �o remove same upon nolice <br />Irmn Ihe GIy and lo �eplace public propeety tlarragetl Ihereby. <br />/`, � <br />� �✓ <br />SIGNATUPE OF APPLICPNi <br />nooaess , <br />- '� � `�� ..,. <br />� ..�' .-/ � � <br />CITv ZIP <br />;: �� - i�•� 'f ' .% ..% F�� ' .�. <br />tELEVHON[ N�M�E� hIiEANNE <br />� � % f _— _ <br />DhYE <br />�'� <br />