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everett <br />� APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or prin. cicarly wi�h ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WOPKS . <br />EVERETT, WASHINGTON n /� �_� PEFiM1T NO. � ZS <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: ��U�U '--�e /'��"a—� <br />HEREBY APPLIES FOR PERAIISSION TO /��( C CSS %NN{2 �`� �L E`/ <br />AT THF FOLLOWING LOCATION /`��� �2p i rl <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <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 />SEWER <br />I0(1/ INAGE <br />� WATER <br />STREET <br />�;! �..��', <br />aPPROV �FOR CON6TRUC <br />I 1 B11��,�.RxAu <br />COMMUNiCAtIONS <br />iRAGiIC <br />rl %r <br />�� � <br />�!�� PC NNING��I � �- ' 1 �� <br />��:. : � � 11.� <br />,:� <br />Ir� P �'� <br />i. , i �< i. � i _ __. <br />CONS: ,UCTIOiJ/AS [3UII.T <br />'/$oZ I <br />DRIVEWAY SECTION <br />� � <br />I�� LIP <br />� 30' �I� 30" <br />The undersigned awner �creby ogrees lo holtl anE seve �armless <br />t�e Cily ol Everell Imm any antl oll <laims lor tlamages. msts. <br />expenses. or causes ol action Ihal n'.ay anse because ot installa!ion <br />and main�enance o� I�e improvement or oil�er rign4ol-wny use <br />hereto apphetl lor antl lur��e� agrees �o remove same u0on nuuce <br />IrOm ihe Cily and Io repiace pubbc p�operty aamnqea iM1ereOy. <br />��..�i/Y�J 1 .�(_Ct� <br />$IGNAiUnE UL AGFLICANT <br />�'�b% — l2C%✓C <br />AODaE55 <br />_ �'/,1�KL /%� � <br />`�v2� ��3G z���33 <br />iELEPMONE NOf.1�-E/B �J Fl1ERNAtC <br />(� � V / 4 � � �%C/S � <br />CJ <br />OAt <br />