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evert7l <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with Ink <br />PUDLIC'WORKS PRESS HARD - YOU ARE MAKING COME i <br />PERMIT NO. 5lIl6 <br />EVERETT. WASHINGTON <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANNY: <br />?L /L <br />LB �I=f�/l f/v / ��L�y✓rc 11, /�.. <br />PEREBY APPLIES FOR PERMISSION TO — <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />Qug3' I <br />I <br />' I I <br />I � <br />YO 1 I, <br />t l0 <br />MA ✓. l <br />k t:t C,3 -� B <br />N <br />(L (IS'JIAI(j) c, <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 />SEWR <br />DRAINAGE <br />STREET , <br />COMMUNICATE <br />TRAFFIC <br />PLANNIN <br />Sil-3-F1 <br />(0%949 <br />DRIVEWAY SECTION <br />I <br />j I" LIP <br />1 <br />L30" <br />The undersigned owner hereby ag,ces 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 mamtenanca of the Improvement or other nghl way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace Putll L property damaged thereby. <br />$IGW, E OF APPPLICA <br />ADDRESS <br />lL9L0/ <br />[IP <br />CITv <br />TELEPHONE NUMBER All ERNATE <br />�� , s Z LIB <br />OAIE <br />