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CVCrCtt <br />._Gglz 13wr-AL-y 8L-VD <br />No . 23 g) a <br />i� <br />117 <br />n 11 -TG <br />K Pu <br />'4I <br />1 <br />Tltj& <br />�5,06 <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC NORKS <br />EVERETT. WASHINGTON <br />PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY:- �I Ic <br />HEREBY APPL' -S FOR PERMISSION TO /S, I fx ,A;,c GFr: <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: I, i <br />/ o� <br />�'S oV �e�cewta�e <br />C <br />/e m ° e <br />C) `�P� L a�Ns� '✓ e <br />/ e w <br />O k Lo ° �d� <br />i� <br />512 Yi <br />j�le (- <br />I <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POS'ED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE ' <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />/� 3�zSi�lwy/ <br />An <br />nrrnuvEU FfaR CONSTRUCTION ��rE <br />APPROVED AS CONSTRUCTED Dorf <br />INITIAL INSPECTION REQUESTED <br />DRIVEWAY SECTION <br />j I" LIP <br />33_01, <br />I <br />The undersigned owner hereby agrees to hold and Save harmless <br />the City of Everett from any and all claims for damages. costs. <br />expenses. or causes of action that may arise because of Installation <br />and maintenance of the improvemenl or other right-ol-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />SIONATU9 OF APPLICANT ' <br />l4/a <br />ADORESs <br />GIT tP ]y 9hQV <br />53 -`U&, <br />TELEPHONE NU e R ALTERNATE <br />DATE <br />3-/9- S1 <br />- <br />FEE 1978 <br />i <br />