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Fa <br />r <br />L <br />e r.•relt <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS )-1 t- I <br />EVERETT. WASHINGTON I I PERMIT NO. 'RD/4 35- <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />HEREBY APPLIES FOP PERMISSION <br />_ tc <br />Irs w <br />AT THE FOLLOWING LOCATION /5�7 A f B - �n3 rd. St $,6, P�,Er,PE" wA. /r82o3 <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />41 PLAINS IMI Ro veil qL- 047,e d <br />� •�=iN/fL �RADiN4 of Sf;�Out,[�R 1� L=LEI�fFT�O oi' <br />r-A7Tc,y 131 S1 (Z�4 Te <br />ra <br />/NS,°Ec TOR .i <br />To &,—,' %d / �j& /C Z<je) p& - <br />Si`!T/S% 4C TiD1V <br />F/LG /i1/ PUG�L/C %2/cSNT ors IIV4' -ro PE SuiTiyt��C <br />G, RTliv 0/,sr�4 <br />NFTr/2 <br />SE <br />Iz Cl. <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 />ENT APPROVALS <br />/- 7=� APP OV 1 O c /�� n� z� <br />r J <br />S. ONS g.j D DATE <br />DRIVEWAY SECTION <br />jl" LIP / I <br />I,- 30'.f ��30'1 <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Evafett from any and all claims for damages. costs. <br />eepenaes, or causes of action that may ones because of installation <br />end maintenance of the Improvement or other Rghl-ofway use <br />hereto applied lot and further agrees to remove same upon nonce <br />from the City and to replace public properly damaged thereby. <br />�� �G <br />SIG AATTOF <br />U�R)EIIP Nr <br />✓�—V/ le <br />• TAnT <br />AGGRESS its <br />CITV <br />ZIP <br />tin <br />TELEPHONE NUMBER <br />ALTERNATE <br />//-/O-S© <br />DATE <br />CONSTRUCTION/AS BUILT <br />