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ju-izy <br />APPLICATION FOR RIGhT-OF-WAY USE PERMIT <br />l Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PU9LIC WORKS <br />EVERETT, WASHINGTON PERMIT NO.� <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY:`/.Gl/i — '• G G.d c.IZgj ?, zk6/ 0G— <br />HEREBY APPLIES FOR PERMISSION TO_G -AL.E' �—i /�l/5 'z=Gp�G T �r -2;yp�'10 <br />AT THE FOLLOWING LOCATION <br />53 01 Co <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: I <br />TLwIA� 4PO('313 <br />iz��nou-e ct exls��►h y oI✓�vP rti <br />/? DY /C�-,/ <br />PERMIT IS VALID FOR 60 DAVS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />N/Aml <br />DAlE <br />r! o <br />DATE <br />CONSTRUCTION/AS BUILT <br />DRIVEWAY SECTION <br />( I" LIP <br />30 �T T 30 '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 'ol the Improvement or other righl-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 />S NATURE OF APPLICANT <br />O r <br />ADDRESS <br />IF <br />CITY ZIP <br />I �S sCdy 3 S�1'- 7 F oD <br />TELEPHONE NUMBER ALTERNATE <br />o2-i3 i97rj <br />DATE <br />1978 <br />0 <br />If— <br />