Laserfiche WebLink
everen <br />e <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or priM cleatly with mk <br />PRESS HARD - YOU ARE MAKING COPIES <br />� PERMII' NO._���� <br />� APPLICANT (UNDERSIGNED) AND FL9M REPRESENTED, IF ANY: I l�r I /��f'/SuA <br />PUBLIC WORKS <br />EVEFiETT, WASHING70N <br />F1F.REBY A?PLIES FOR PERMISSION <br />�� <br />.5T THE FOLLOWING LOCATION yZ?��� yC � .S / L v�j'�1/ ✓, n' <br />DRAWING (WORK TO BE DODIF) 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 259-061 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />SEwER <br />oanir�ncE <br />WATER <br />SLR�dEi <br />p /qp FOF CONSTRUG <br />L, <br />I APP OVEO �S U <br />I �ti ' <br />COMMUNILnitONS <br />rnnrric <br />_ PLANNiNG <br />� �/'�/Y/ <br />J oniE <br />� �'� �� <br />� A1 <br />�Oh;STRUCTION/AS 6UILT <br />DRIVEWAY SECTION <br />I � <br />+I„ LIP � <br />�30� �30" <br />Tho unde�5igne:A awner hereEy agreos to holtl antl save harmless <br />tlie City ol EW.rell Imm any antl all claims lor Eemages. cosls. <br />e.penses, or cuuses ol action Iha� may anse because ol inslallaiion <br />an4 mainlenarce el Ihe improvement or other rig�l-ol-way use <br />�erem applietl lor antl Wr�her agrees �o remove 5ame upon nol¢e <br />Irom tM1e Gty and m iepiace pu�i¢ O�oOer�y Oamaged �hmeby, <br />�r[-� (� ��� ���lil l'[ �1Ci�/1�{. <br />SIGNAiUiiE OF AFPLICI' 1 <br />3a�� �� r?� s t _ <br />nooaess �� � <br />!� Ino J c�� IN4 S/� ��,70� <br />L�v � ZiP <br />N^�� a �s G <br />IELE[.�IONE N� A�IERNAiE <br />_�t(�� 7 / 9.P/ _._ <br />onre <br />