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PUBLIC WORKS <br />EVERETT, WASHINGTON <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO.�B <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF AN` <br />HEREBY APPLIES FOR PERMISSION <br />AT THE FOLLOWING LOCATION 4S Z 6 A v P <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <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 />DRAINAGE <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />/ O <br />ApPq V D F R CONSTRUCTION <br />VED AS CONSTRUCTED <br />CONSTRUCTION/AS BUILT <br />rr {o iS1c.G.x�c— <br />DRIVEWAY SECTION <br />I" LIP <br />I 30r _I- -- 30'_f <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 ether nght-of-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 />f r7 .lid <br />SIGNATURE OF ARRLIG - L t .El>_ <br />ADDRESS .I .i lr y t�r <br />F--�Jeap=-T 0�8Z0� <br />Crry ZP <br />353-128 �8 1. <br />TELEPNOHE NUMBER LTERNATE <br />