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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with inkeveren <br />PRESS HARD - YOU ARE MAKING COPIES i <br />PUBLIC WORKS <br />PERMIT NO. <br />EVERETl. WASHINGTON 1`r / ✓/� Q/� �✓ <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANV. ---- <br />HEREBY APPLIES FOR PERMISSION T <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />" qf E,Pe t51 rNH-er <br />1 <br />QEf ntw CElc v.1 A1" N c NIIA In` <br />1 �MG J <br />fAN L. 1 r. -11, • R-11>w <br />�Ne+.A LL C.o.�P�op.l,�ey <br />Pt P v< <br />pliVWA4Y <br />PERMIT IS VALID FOR 60 DAYS <br />COFY OF THIS APPLICATION TO BE POSTED <br />Or JOBSITE. <br />CALL FOR INSPECTION 259-981 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APFROVALS <br />COMMUNICATIONS- <br />SEWER <br />-� <br />iNAFgC <br />DRAINAO <br />PLANNIN <br />WATER <br />;PPKOM FOR CUP11I mul.... <br />zgl <br />1��_ OAl <br />RROVE NS L...a U E <br />�i/� CONSTRUCTION/AS BUILT <br />4vusg <br />CONDITIONS <br />Applicant acknowledges that the City <br />will not be responsible for blockages <br />in proposed 411 drain line or possible <br />high water bsckflows that may occur <br />because of tile. flatness of 4" drain <br />line. i <br />Sign —of Applicant <br />DRIVEWAY SECTION <br />I---- �I LIP _ <br />I'3011 -�30 1\ <br />The undersigned owner hereby agrees to hold and Be" harmless <br />Ina city of Everett from any end all claims for damages. Coats. <br />matallation <br />intenance 0, cal causes <br />f action <br />Ihal,ment " other H9ht ofmay rise tuicause of eway use <br />and <br />hereto <br />tlity to, <br />and JuHhe, d a <br />from the Canla replacepublcl e <br />property damagedlhaoeby. <br />YY �— <br />$LL1N T E �APPOIAW <br />v <br />004- <br />ADDRESS <br />✓.Y e.// Y <br />9C re- T 2 P <br />CITY <br />g2634 AUERN IE <br />TELEPHONE N PEN I <br />�j <br />D�+E <br />N <br />