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everetl <br />APPLICATION FORBRIGHTor rint YOFwith ^kWAY USE PERMIT <br />Type PRESS HARD - YOU ARE MAKING COPIES <br />PERMIT NO. o l� <br />PUBLIC WORKS <br />EVERETT, WASHINGTON � � <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY: <br />s—rl%lri :R <br />HEREBY APPLIES FOR PERMISSION TO <br />N <br />AT THE FOLLOWING LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />I' l LI <br />VOL cfLfUsC <br />I � i <br />1 <br />u� fU i <br />I , <br />ac <br />MA M. <br />':!�—_ (:�p(-u, Dto <br />F <br />RMIT IS VALID FOR 60 DAYS <br />OF THIS APPLICATION TO BE POSTED <br />OBSITE. <br />CAI-2 HOURCTI <br />S BEFORE CONSTRUCSPIEECTION TION <br />' ' <br />DEPARTMENT APPROVALS <br />I <br />— COMMUNICATIONS <br />SEWER <br />TRAFFIC <br />DRAINAGE <br />PLANNIN <br />WATER <br />STREET <br />DATE <br />PPR� O��ONSTRUCTION — <br />NSTRUCTION/AS BUILT <br />q PHri cA <br />CA <br />DRIVEWAY SECTION <br />I 30" <br />The undersigned owner hereby agrees 10 hold and save harmless <br />me City of Everett from any and all claims for damages striation <br />costs. <br />expenses. or causes of action that may arise because of inslalRhOn <br />and ma of the Improvement or other ❑ght-Of-Way use <br />as <br />ve sa <br />hereotheplied City lt andland to furt eceurtheragile ipropely tlamegedupon <br />thereby. <br />from <br />SIGNAT E OF APPLICA <br />c,213 1 o () <br />ADDRESS /lK (G <br />/ e <br />city <br />��� <br />— �/i7i/�' <br />TELEPNOFIE NUMBER <br />.. <br />DATE I <br />, <br />