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APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with ink <br />Ed] PRESS HARD - YOU ARE MAKING CCPIES , <br />PUBLIC WORKS rj i7 <br />PERMIT NO. <br />EVERETT, WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: Q19V I Q L 1V1 LOP i r/' <br />_ A <br />HEREBY APPLIES FOR <br />AT THE FOLLOWING LOCATION—'—� <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR GO DAYS <br />COPY OF THIS APPLICATION TO FIE POSTED <br />ON JOBSITE. <br />GALL FOR INSPECTION 2591-881 1 <br />24 HOURS BEFORE CONSI-RUCTION <br />SEWER <br />DRAINAGE <br />STREET <br />DEPARTMENT APPROVALS <br />4OMMUNICAT <br />PLANNING <br />APPROVED FOR CONSTRUCTION DATE <br />APPROVED AS COI:STRUCTED oATE <br />CUSTOMER <br />N Ko"I l <br />y /9 try <br />v'j/V <br />xset-(3 S.2- <br />DRIVEWAY SECTION <br />I" LIP <br />r 30� •30" l <br />T 1 <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 improvement or other right-ol-way use <br />hereto applied for and further agrees to remove some, upon notice <br />from the City and to replace public property damaged thereby <br />SIGNATOF APPL Ia 11 <br />�// (4 -11)(6>/ <br />ADO.Ebb <br />2CCi 112� .SS �4nFs <br />TELEPHONE NUMBER ALTERNATE <br />/ / .2,n <br />OAT <br />1978 <br />