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ju-ky <br />U APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly wdh ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS y <br />EVERETT, WASHINGTON //// PERMIT N0.1� <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY. L//C'6j�' —' �(,/ " �G <br />HEREBY APPLIES FOR PERMISSION TO G�% - / 5 �T <br />AT TI4E FOLLOWING LOCATION <br />s3o/ C0 <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />dw11\9 <br />1 e x; s�-1 Iih <br />S / Z- .� Xt <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 />SEWER <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />Id <br />7 :1 <br />DRIVEWAY SECTION <br />&0. <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' malNanance of the Improvement or 0i righ401-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 />y 'NA URE U[ nV{'L ICANI <br />ADDRESS % <br />. GUI+ Puy <br />CIT. SIP <br />3 �s Goo 3 fS-- -2 F o0 <br />TELEPHONE NUMBER ALTERNATE <br />;;2--i3-i973 <br />DATE <br />