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everen , <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 <br />EVERETT. WASHINGTON PERMIT NO.T,� <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: AL4 F. SAAct _ <br />HEREBY APPLIES FOR PERMISSION TO use C!�"&sfe; cli, I /n a .Q <br />AT THE FOLLOWING LOCATION _1/19 2 rid, _ <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />a e <br />D <br />c�I @rOevV rf <br />ec °'n f � '� 40Ns <br />,le'v0 e <br />SL-) o� I-r�L4oce. <br />512 Y/ <br />Lp,eG <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-661 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />DRAINAGE TRAFFIC <br />PLANNING <br />STREET <br />AFPRUVEO FJR E-N RU ION r DATE <br />APPROVED AS CONSTRUCTED DATE <br />DRIVEWAY SECTION <br />I <br />I" LIP <br />30" <br />The undersigned owner here jy 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 improvement or other rlght-of-Way use <br />hereto applied for and further agrees to remove same upon notice <br />hom the City and to replace public property damaged thereby. <br />N _ <br />SIGNATU7 OF APPLICANT <br />I <br />ADDRESS <br />- <br />CITY LIP923 94 <br />3S3 -1Ug��n <br />TELEPHONF. NUMTq ALTERNATE <br />3-'j9- rF1 <br />DATE <br />