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evere:� <br />� APPLICATION FOR RIGHT-OF-WAY USE <br />Type or pnnt clearly wdh ink <br />PfiESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT,WASHINGTON <br />APPIICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: <br />HEREBY APPLIES FOR PERMISSION TO. <br />C:�IPcI ���, �\:�:,4'�� t� <br />AT THE FO� �. .WING LOCATION <br />'-� �4 v <br />5 <br />DRAWING (WORK TO BE DONE) OR THREE PLA'!S ATTACHED: <br />�rf <br />PERMIT ��� � <br />� <br />�RM�N . � <br />!N <br />._';����\� (� ��� <br />� " �`�/ <br />� � �. (�.� U �;� s -�'� � �- �� � ��� �-r-r��—� <br />� ��S�r�t� ��c�z�..� �S�.�G�,�rG� (wt�J(�11-`�''�1��i7-S ���.. <br />� I <br />( LC�.� t.,v�"`c.0 �� �QS�P..t���'1 Sc �C�: �� - <br />`U�,� {�„ ���!�(-1�-�`Q <br />� ��` � � � <br />_ l. � ( f ai <br />�'�%-('(�`_ �C� r7i_ '!�';,}i _ (. <br />J 5 S -7� �^"�o��t�uu�a�.� <br />r� <br />��� j �,,�� ��� �.�/G�t S �`�0 �/ <br />i <br />PERMIT IS V'ALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR IO�ISP�ECT�ON 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />i � � ,� % — <br />nP OVEG AS CONSTRI) ` D U.+�F <br />I� ' 1 <br />DRIVEWAY SECTION <br />� <br />� �I <br />I" LIP ] <br />I—�30�___ 30 hj <br />I�— i -- --'� � <br />Tne un�ersigned owner hereby agrees !o holtl and save harn'.'.� . <br />Ihe Cily ol Evereu Irom any antl all claims for damages. �....,�_ <br />ezpenses. or cnums o� nninn Ihnl m�y arise becnuse ol �m,tn�.'.�•,- . <br />Ond md�nlc . .. ..: �P, . ..., i.i. � ., ��iL.r, nn � I ..�. � <br />hciBlU aPVI t,.i ,iin�� � , n�._., ......� ,. ....p�,. <br />Iram Ihc � � .,.. . _.� . .... . . . <br />,-� <br />� <br />� <br />, <br />� I �j' �� u.; _ u;� . ��-- <br />��— �SIGNAtURE 0� AVFLICANi <br />-�(' � '/ , J_� .. � <br />.,✓'✓�� �.� � �';�,�(J4C <br />CRY ZiP <br />-) �i r. , . <br />,jJ J � ) �� ' ,J.%.��� .. . , <br />iELEP�iCNE NUMOCR / j qL1E�NAiF <br />�,?r' — .r[� <br />j � . <br />. .. . �'� _. ' <br />I� <br />