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s? 93 <br />everett ' <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly With :nk <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON <br />PER%MIIT NO. T/ S <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED. IF ANY: M l / { G— AJ I CAA15 a—s <br />HEREBY APPLIES FOR PERMISSION TO C U A.%$ I K UL I 17 UN IT A,,LI-)CA . <br />AT THE FOLLOWING LOCATION_ <br />v ' <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />/irlc � uvi�✓ y—o <br />PERMIT IS VALID FOR 60 DAYS <br />uc Tic c <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 />DRAINAGE TRAFFIC <br />I _ <br />Lylr(��.'r <br />T <br />STREET <br />DRIVEWAY SECTION <br />I 3olt--� 30" <br />The undersigned owner hin:by agrees to hold and save harmless <br />the City of Everett from any and all claims for damages. costs. <br />expenses. or causes yf action that may arise because of installation <br />and maintenance oil the Improvement or other right•ot-.ay use <br />hereto applied for and further agrees to remove same upon nonce <br />from the City and to replace public property damaged thereby. <br />6-CRRy /C WAS <br />y SIG E OF APPLICANT �- <br />5`73J ,:�' 3. P . �.w - <br />ADDRESS <br />CITY ZIP <br />-7'/3— 5691 7Y3 - 79/z <br />TELEPHONE NUMBER ALTERNATE <br />