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gS3 s <br />rverett <br />Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />�j Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS —r <br />EVERETT, WASHINGTON �PERMIT NO. i{ Ifs <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />3— }���"&G h' <br />HEREBY APPLIES FOR PERMISSION TO �U.n� �V'r1V ''G', Delya SVIrtt4B (.� <br />Fob 4PrT1 ASP�1 $J PA1)WG ep DF-A(QAc� <br />AT THE FOLLOWING LOCATION ^� /q k .6 MA11v WAS 9Wa3` <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION 259-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />DRAINAGE <br />PLANNING <br />STREET <br />APPROVVED FO CONSTRUCTI N DATE <br />AP OVED AS COEI$TRU D DATE <br />CONSTRUCTION!AS BUILT <br />DRIVEWAY SECTION <br />\ It I" LIP <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 nghl-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 />ADORESS <br />G-ll <br />CITv ZIP <br />2S�1-S573 ZSL-110% <br />TELEPHONE NUMBER ALTERNATE <br />1 I -- 5-90 --- <br />DATE <br />