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��53 r <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Tppe Or print clearly with inkeveretl <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT. WASHINGTON PERMIT NO._,>D� <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: y�� <br />HEREBY APPLIES FOR PERMISSION TO 1W 7`n VL W\1 'L-tEb <br />Ipof- 1\5p0mt, flr iNfNA(Se <br />AT THE FOLL^WING LOCATION 2116 A e MAIN SA & A, 98203 <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 />/'g /2 -2.-Ro <br />APPROVEDFO CONSTRUCTI N DATE <br />�` Y n / <br />AP OVED AS CONSTRU D � J DATE <br />CONSTRUCTION/AS BUILT <br />DRIVEWAY SECTION <br />I' <br />I� +I" LIP �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 of the Improvement or other right-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 />AODRESS <br />G-V UVIM <br />CITY ZIP <br />25ri-5S7 3 ? 9-)--1 <br />TELEPHONE NUMBER <br />ALTERNATE <br />11- S-•FSV <br />1978 <br />